Age_Shoultz1'
APPLICATION FOR SENIOR CITIZEN T i Y�
. PROPERTY TAX BENEFITS
S -' Stata Form 43708 (R9 / 9-08)
Presmbed by Na Departmarrt of Laal Govammer� Finance
C/� q�IF
Information containetl in Nis doaiment is CONFIDEMIAL pursuant to IC b1.142-9 antl IC Gt.t-359. �Cl, fi` L
INSTRUCTIONS: C.�J.���
To be filed in person orby mail wi(h fhe CountyAudHor o/the munty whera fhe property is locatetl.
Filing Dafes: 1J Rea/ Property: Dunng the twelve (12) months be/ore December 31 0l the yeer the deducti��� �9�Y AUDITOR
2J Mobile Hanes assessed urMer IC 61.1-7 or manu/actured hanes rrot assessed as real pioperfy.� Durirg Ihe twaNe (12) months
be/ae Maldr 37 07 the year the deduction is l0 6e eRadive.
See reverse side !w addifional instivcfions aiW qualifications
TYPa ��neEt `epue5ed �please rheck aH Nat apply) ,�,.(
�Over 65 Deduclion from Assessed Valuation �J Over 65 Circuit Breaker Credit
Name o( apqicanl (mmer or conbaG 6uyeQ
VY `�LCxriy �
Is appGpiri the sde lepal or equitaNe owne(7 w inte`es17 N awned wilh svrtreone olher ihan spoum,
'vditata with whom
❑ Yes ❑ No
If nama on racard is ditlarent than that ot appircan( indicate bebw
Name d con�aa seaer (apprlcant must nare eaen euyiry m c«nraa al �east orre (iJ year)
Address o( contratl mAer (mimber and sbaef, ciy, sta�. aM LP mtle) Is iha Pmperty in Quesl'on:
� Real pioperty � Mobile home (fC E7-1-n
Tazin di tricl Key number / Legal Cescnption Remrtl numbar Page num6er
a,�-�� a� ��a-��-���_ oUO. � 3y.� �
Is �ha p�opeM � and ocwpied pnmarily (or AssesseC value of Ne pmDefty as of Maich 1, �vrter.t year (may mf armed 5182,430
Nsiher residanw7 !oi 0`er 65 dedadion, u� S1b0,000/or flm Ovar 65 CBnit &aakar GadrQ
�Yes ❑ No
Was Ihe applican165 years af age or more on December 31 of Ne year
Have you filed tar a�ry other dedu�ais7 tl 14s. wha� deducliorts?
� Yes ❑ No �
tu�a ra �ea ror em�so� � ar�r adm wn++r? u�..+na� �m+rx
❑ Yes ❑ No
IIWe cerlify under penalty of peryury that the above and foregoing information is We and cortect and lhat the appiicant was a �esident
of Indiana and owner of the aforementioned property on March 1, 20
Sig lureda Pddresso(applinrrt(nwnbaraMStreef,riry,stab,aMZlPmda)
` � (.P
Signatu�e o(auNwaed represantatre � drass of autMimd repeesenbtiva (num0er sLaef, cify. sfete, andLP co0e)