Age_McCandless ' ;,a. APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR j
"°' PROPERTY TAX BENEFITS iT
State Form 43708(R9l 9-08
•� 1n. �f Prescribed by the Department of Local Government Finance y"�
2 le Mark
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.1-35-9. OCT 2 2014
INSTRUCTIONS:
To be sled 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 deduc(°IH' t , TY 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 benefit requested(please check all that apply)
VA er 65 Deduction from Assessed Valuationver 65 Circuit Breaker Credit
Name of appfxant(owner or contract buyer) Q -(`�+,(, P
Qr•� � IS Q+, t Si)O 9 1 YT CP t O( L-SE 7S h1. , l_
Is app rd`the sole legal or equitable owner? , 'j to,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 bean buying an contract at least one(1)year)
Address of contract seller(number and street,city,state,and ZIP code) Is the properly in question:
r A Real property ❑ Mobile home(IC 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
p, „D la1.- ((-\ -304;-0oc.(9(5-6aR
Is the property used and occupied primarily kr Assessed value of the property as of March 1,current year(may not exceed 3182,430
his/her residence? for Over 65 deduction,or 8160,000 for the Over 65 Circuit Breaker Credit)
Wes ❑ No
Was the applicant 65 years of age or more on December 31 of the year
Have you filed for any other deductions? It Yes,what deductions?
e ❑ No
Have you filed for deductions in any other county? If Yes,what county?
❑ Yes Wo
INVe 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 and street,city,state,and ZIP code)
r n
l9Beu.{SIeL ?Me-C4.d/C (/��Kio,�,Ay -. UU'
Signature of authorized representative Address of authorized re{lesentalive (number and street,city,state,and ZIP code)