Age_Messersmith •
CIAPPLICATION FOR SENIOR CITIZEN COUNTY I TOWNSHIP YEAR
PROPERTY TAX BENEFITS Igo
� %' Stare Form 43708(R10/12-06)
u• Prescribed by the Department of Local Government Finance
File Mark
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 andt11#%O -9.
I
INSTRUCTIONS: vt t` 1
S l
To be riled in person or by mail with the County Auditor of the county where the pro ' s' =:; „I P'11 -
Filing Dates: 1) Real Property:During the twelve(12)months before Decembe q.' .�: -'6r�E Reduction is to ective.
2) Mobile Homes assessed under IC 6-1.1-7 or manufactis e,S9 es 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)
❑ Over 65 Deduction from Assessed Valuation , Over 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer) �"
'l7 arliPNA °k- GZR O4 N 3\Aril_�-k/� 1 1.
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 ❑ 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:
Deal property ❑ Mobile home(IC 6-1-1-7)
Taxing district - Key number/Legal description Record number Page number
Q J2nro-2CJ.9Ca 2G- 13- 19 • Z6M - O00 . tT8- 005
Is the property used and occupied primarily for Assessed value of the property as of March 1,current year(may not exceed$182,430
his/her residence? for Over 65 deduction,or$160,000 for the Over 65 Circuit Breaker Credit)
❑ Yes ❑ No
Was the applicant 65 years of age or more on December 31 of the year
Have you filed for any other deductions? If Yes,what deductions?
, Yes El No /)s, 5
Have you filed for deductions in any other county? If Yes,what county?
❑ Yes ❑ No
Me 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)
-2/1/ -5d TA' /7"7:41 /9o_ an
Signature of authorized representative Address of authorized representative (number and street,city,state,and ZIP code)