Age_Patterson (2) A. APPLICATION FOR SENIOR CITIZEN • • •f TO SHIP I YEAR j
' PROPERTY TAX BENEFITS !D
` State Form 43708(R9/9-08)
• • Prescribed by the Department of Local Government Finance APR q�r eLtrf� I
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.1-35-9. A R `rrl r'd
To INSTRUCTIONS:ed in person 7f
To be filed in person or by mail with the CountyAuditor of the county where the property is located. rr�cc cc 'f'o'A'."�i� M,.
Filing Dates: 1) Real Property During the twelve(12)months before December 31 of the year the deduc4Oh`r1`igthl QTY 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 to be effective.
See reverse side for additional instructions and qualifications.
Type of benent requested(please check all that apply)
,Over 65 Deduction from Assessed Valuation ,Over 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer)
;0-tea- ,. .4.--01..e'legal or equil a owner? If No.what 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 6-1-1-7)
�Taxin district Key number/Legal description Record number Page number
� a�_�� _33 goo -ooi soy z
Is the property used and occupied ' city for Assessed value of the property as of March 1,current year(may not exceed$182,430
his/her residence? for Over 65 deduction,or$160,000 for the Over 65 Circuit Breaker Credit)
❑ Yes ❑ No
Was the applicant 65 years of age or more on December 31 of the year Applicant's date of birth(month,day,year) If filed by a surviving,unmarried spouse,
prior t current year 'what was the spouse's age at the time
E—Yes ❑ No /a ,/^ /9 `l J of death?
Adjuste gross of applicant, spouse, and any Source of Income Amount of Income
individuals sharing ownership(For Over 65 deduction,income $
may not exceed$25,000;for the Over 65 Circuit Breaker Credit, . .
income may not exceed$30,000 for individuals,or$40,000 for $
married couples). ,
TOTAL $ 0.00
Have you filed for any other deductions? If Yes,what deductions?
Nr
Yes f No /11 S en t,
f9J
Have you filed for deductions in any other county? If Yes,what coup
111 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 .
Sig 'of applicant Address of applicant (number and street,city,state,and ZIP code)
_ '^_a > X025oa A5-. 415G 65->c_ cT f nce.fA XiiYlkia
Signature of authorized representative Address of authorized representative (number and street,city,slate,and ZIP code)