Age_Briggs 'x:.,4. APPLICATION FOR SENIOR CITIZEN COUNTY I TOWNSHIP I YEAR '
:::;=11. PROPERTY TAX BENEFITS FILEt)
" State Form 43708(R9/9-08)
"_-,r
i.,. Prescribed by the Department of Local Government Finance
ile Mark
Information contained in this document is CONFIDENTIAL pursuant to IC 6-11-12-9 and IC 6-1.1-35-9. DEC (J 2013
INSTRUCTIONS: Jn(�,.�
To be filed in person or by mail with the CountyAuditor of the county where the property is located. /�'tr/1LL
Filing Dates: 1) Real Property:During the twelve(12)months before December 31 of the year the deducte1B$Q NTy AI In r
2) Mobile Homes assessed under IC 6-I.1-7 or manufactured homes not assessed as real property:During the twelve(12)moorlfl+3
before March 31 of the year the deduction is to be effective.
See reverse side for additional instructions and qualifications.
Type of benett requested(please(heck aD that apply)
glOver 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
pNam applicant(owner or contract buyer)
4 /6t4A QQN j -
Is applicant the sole legal or equitable owner? If No,what is his/her exact share or interest? If owned with someone other than spouse,
indicate with whom
❑ Yes 0 N
If name on record is different than that of applicant,indicate below
Name of contract seller(applicant must have been buys g on contract at least one(1)year)
Address of contract seller(number and sheet,city,state,and ZIP code) Is the property in question:
-®Real property ❑ Mobile home(IC 6-1-1-7)
Taxing trill Key number/Legal description Record number Page number
_ .ze -ia -c�_3o3 -ooy 3,L-40 X8
Is the property used and occupied unmanly for Assessed value of the property as of March 1,current year(may not exceed 5182,430
hislher residence? �q' for Over 65 deduction,Cr 5160,000 for the Over 65 Circuit Breaker Credit)
F� 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,unmanied spouse,
prior to the arrant year?
Have you filed for any other deductions? If Yes,what deductions?
vg Yes Fl No 19S
Have you fled for deductions in any other many? If lbs,what county?
nYes ktNo
IAVe 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 •
XSignature of applicant Address of applicant (number and street,city:state,and ZIP code)
\ EQi�(WSIy�] Vac w. (),kz,,IDe a,L 7n.,) t!-r✓ 9776 76
Signature represe Address of authorized representative (number and street,city,state,and ZIP code)
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