Age_Massey ^1;"a APPLICATION FOR SENIOR CITIZEN COUNTY I TOWNSHIP YEAR •
`"'4 PROPERTY TAX BENEFITS T y
State Form 43708 B)
MIS Prescribed by the Department of Loral Government Finance
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.1-35-9.
JUN 6 2014
INSTRUCTIONS:
To be Filed in person or by mail with the CountyAuditor 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 deduction is to v d
r Yrinb,��1months
2) Mobile Homes assessed under lC 6-1.1-7 or manufactured homes not assessed as real ftHIQr@rr or; - DUI I
before March 31 of the year the deduction is to be effective. DUI
See reverse side for additional instructions and qualifications.
Type of benefit requested(please check all that apply)
ZOver 65 Deduction from Assessed Valuation ell Over 65 Circuit Breaker Credit
Name of ipdicant(C buyer)
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 111 No
If name on record is different than that of applicant,indicate below
Name of contract seller(applicant must have been buying an 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)
Testa c Key number/Legal description Record number
Fo la -o1 - /ol .Oo�. 3? 6 - oz8 Page number
Is the property used and occupied primarily br 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)
j�j Yes ❑ 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\bs,what county?
❑ Yes 0 N
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 of applicant Address of applicant (number anted street,city state,and ZIP code)
fSi5nature6(auth ed representative Address of authorized representative (number and street,city,state,and ZIP code)
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