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Age_Caudill Sit APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR --. : V PROPERTY TAX BENEFITS F i _ED \` State Form 43708(R9/9-08) \ra:/ Prescribed by the Department of Local Government Finance 3 Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.1-35-9. FEB 3 2014 File Mark To INSTRUCTIONS:filedi person n' To be filed in person or by mail with the CountyAudHor of the county where the property is located. JT lwL`, Filing Dates: 1) Real Property:During the twelve(12)months before December 31 of the year ttiElaebfitldnv€T jswe000 ITOR 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 benefit requested(please Mock all that apply) giOver 65 Deduction from Assessed Valuation ® Over 65 Circuit Breaker Credit Name of applicant t((owwner or co�ntr/[raact buyer)e pit 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, I� indicate with whom I t I 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) Taxing district Key number/Legal description Record number Page number r .A44 ltd 016-n-tlegoy_ 000,333--o2 sit Is the property used and occupied primarily for Assessed value of the property as of March 1,current year(may not exceed 5182,430 his/her residence? for Over 65 deduction,or$160,000 for the Over 65 Circuit Breaker Credit) aces El No Was the applicant 65 years of age or more on December 31 of the year Have you filed for deductions in any other county? If Yes,what county? III Yes ID 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 . YSignature of applicant // Address of applicant (number and street,dry,state,and ZIP code) Signature of authorized representative Address of authorized representative (number and street,city,stare,and ZIP code) ill ti fair