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SAPPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR •
PROPERTY TAX BENEFITS I I ,L
State Form 43708(t,9/9-08)
Prescribed by the Department of Local Government Finance
ryy�' 1 . File Mark
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.1-35-9. r Y�L�lE� -241.2-�]
INSTRUCTIONS: M�/ ��,J
To be filed in person or by mail with the CounfyAuditor of the county where the property is located. l�f �� �i
Filing Dates: 1) Real Property:During the twelve(12)months before December 31 of the year the date:880W•;6'.:A•,‘
miming
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as mat property:During the twelve rtz months
before March 31 of the year the deduction is to be effective.
See reverse side for additional instructions and qualifications.
Type of benefit requested ease check a that apply)
Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name/,4 ppfdicant,(.owwn/err or contract buyer) v
Is applicant the sole legal or equitable owner? If exact share or interest? If owned with someone other than spouse.
acesindicate with whom
[ Yes ❑ No
If name on record is different than that of applicant,indicate below
Name of contract seller(apprmant must have been buying on contract at least one(I)yead
Address of=tract seller(number and street,city,state,and ZIP code) Is the property in question:
❑ Real property ❑ Mobile home(IC 6-1-1-7)
Taxing " id� Key number I Legal description Retold number Page number
a6 - 7 // - 20/ - 000. /82-40/
Is the property used and occupied primarily for
Have you filed for any other deductions? wit If Yess,what deductions?
l7y Yes ❑ No 41 S
Have you fled for deductions in any other county? If Yes,what county?
❑ Yes 0 N
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
Signature of applicant Address of applicant (number and street,city,state,and ZIP code)
)C f( (Irrr..-1.4.4., -t X, S6 Fs S / f 7 @Q-�L-.,k Ems, �'it 7GG o
Signature of authorized representative Address of authorized re )fi
(^^` representative ( tier and sboet dry,state,and ZIP code