Age_Patterson I-rt."... APPLICATION FOR SENIOR CITIZEN TO SHIP YEAR
`F''�1 PROPERTY TAX BENEFITS I I & iD
.„: --- State Form 43708(R9/9-08)
r u Presented by the Department of Local Government Finance r��t e]�}�r}1
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.1-35-9. APR tgl Ltt'�r
INSTRUCTIONS: U
To be filed in person or by mail with the County Auditor of the county where the property is located. f�
Filing Dates: 1) Real Property:During the twelve(12)months before December 31 of the year the deducAMPEN aaQUAITY AUDITOR
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as real property:During the twelve(12)months
before March 31 of the year the deduction is fo be effective.
See reverse side for additional instructions and qualifications.
Type of beneft requested(please check all that apply)
,Over 65 Deduction from Assessed Valuation ,Over 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer)
� ? 1' �
Is appca a sole legal or ammer If is his/her exact share or interest? If owned with someone other than spouse,
indicate with whom
❑ Yes ❑ No
If name on record is different than that of applicant,indicate below
Name of contract seller(applicant must have been buying on contract at least one(1)year)
Address of contract seller(number and street,city,state,and ZIP code) Is the property in question:
❑ Real property ❑ Mobile home(IC 6-1-7-7)
Toxin district Key number/Legal description Record number Page number
Ta� a{o..../2 .33 goo -ool. so/ o x
Is the property used and occupied dry for Assessed value of the properly as of March 1,current year(may not exceed 5162,430
his/her residence? for Over 65 deduction,or 5160,000 for the Over 65 Circuit Breaker Credit)
❑ Yes ❑ No
Was the applicant 65 years of age or morn on December 31 of the year
❑ Yes ❑ No
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 •
\ (— Sig 1 of applicant Address of applicant (number and street,city,state,and ZIP code)
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Signature of authorized representative Address of authorized representative (number and stmet,city,state,and ZIP code)