Age_Sisk (2)r�
'" APPLICATION FOR SENIOR CITIZEN
. PROPERTY TAX BENEFITS
S Sfate Fam 43708 (R9 / 9-08)
� Prascnbed by the Oepa�tmerit of Loral Govamniar�t Finance
Informatiom m�tained in this do�ument is CONFIDEMIAL pursuan[ [o IC 6-7.1-12-9 and IC G1.135-9.
INSTRUCTIONS:
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To be filed in person or by mail wiU� Ihe CountyAUditw ol (he munry where the propeAy is located.
Filirrg Dates: 1) Real Property: Dunng Ihe twefve (72) mwdhs 6efae December 37 0/ the ysar fhe tleducfim is to be effectire.
2) Mobile Homes assessed urMer IC 67. 7-7 or manWactuled homes �rot assessed as reel property Dunrg fhe fweNe (12) months
be(ae March 31 0( fhe year the deduction is to 6e eflactive.
See reverse side lw addilional insWUions arM qualificffiims.
Typa of baneft repueSeE �o m� m�� aaaryl
Over 65 Deduction 6om Assessed Valuation Over 65 Circuit Breaker Credit
Namedep acmfrxtWryoQ —
b applimrtl t sda legal ar e ame If No, what is hisRier exatl share or interesl7 If owned wilh saneone ot�er ihan spoum,
indirate wilh whom
Yes ❑ No
H name u dMarant Iha Ihat d eppfimnt, indicate be
Name d selier (appLCanf mus e bem uyirig on canfracf at least orre (1J yea�
Pddrass d cmtrad SeAer (numbar aM street, city. sFab. end LP wEe) Is Ihe Pmperty in Ques�ion:
Real pmperty � Mobila homa (IC 6-74-�
Tazing ' d Kay number / Legal Cescrip(ron ecord number Page number
-�l/� lo- -/1�-00/. ��-Oozd
Is Ihe pmperty used antl ompieE primarily tor lsssessed value of Ihe pmperty az of Mamh 1, wneM year (may rrof oxceotl E7B2,430
hisRier residen�sT for Oiei 65 daduCion, a� 5160,000lor No Orer 65 Circut Brealsr Crediq
❑ Yes ❑ No
VJas Ne appl'vaM fi5 years of age a mae on Decembar 31 of the year
Have you (Jed tv any mher dedwrirns7 If 1§s, what dedurl:rons?
� Yes � No
Have yw FJed (w deductions in any other caunry? It `i4s. what cwnry?
❑ Yes ❑ No
UVJe certify under penalty of perjury that the above and foregoing information is W e and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20
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