Age_Davis nt. A. APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP I YEAR •
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PROPERTY TAX BENEFITS ENEFITS F T L E„. State Form 43708(R9/9-08)
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Prescribed by the Department of Local Government Finance 1 y
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.1-35-9. APR 1 �II 2t014
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor of the county where the property is located. ��
Filing Dates: 1) Real Property:During the twelve(12)months before December 31 of the year the deducQIB�Q� TY AUDITOR
DITO R
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 mverse side for additional instructions and qualifications.
Type of benefit requested(please check all that apply)
Z9over 65 Deduction from Assessed Valuation ❑ Over 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer)
j c..5\....Is applicant the sole legal or�mt owner? I If No,what his/her exact share or interest? If owned with someone other than spouse,
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indicate with whom
pYes ❑ 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 ono(I)year)
Address of contract seller(number and street,city,state,and ZIP code) Is the property in question:
eat property ❑ Mobile home(IC 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
Is the property sect and occupied primarily for Assessed value of t e property as of March 1,current year(may not exceed 5182,430
his/her residen ? m ? for Over 65 deduction,or 5160,000 for the Over 65 Circuit Breaker Credit)
I WYes ❑ No
Was the applicant 65 years of age or more on December 31 of the year
Have you fled for any other deductions? If Yes,what deductions?
Yes ❑ No
Have you filed for deductions in any other county? If Yes,what county?
❑ Yes 10
1/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 ppfoant Address of applicant (number and sheet,city,state,and ZIP code)
u�*-2 Oi �' /194 4/. A-sr & -,$ sngor, /N 476.37
Signal authorized representative dress of authorized representative (number and street.city.state,and ZIP code)