Age_Miller APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP I YEAR I
4 R PROPERTY TAX BENEFITS
}` State Form 43708(R10/12-08)
•�uu Prescribed by the Department of Local Government Finance
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Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.1-35-9.
INSTRUCTIONS: ,1
To be filed in person or by mail with the CountyAuditor of the county where the property is located. APR 16 �015
Filing Dates: 1) Real Property:During the twelve(12)months before December 31 of the year the deduction is to be effective.
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as real property:Durin 1�rlwellve 2)months
before March 31 of the year the deduction is to be effective. GIBSoN CO -
See reverse side for additional instructions and qualifications. UNTY AUDITOR
Type of benefit requested(please check all that apply)
Over 65 Deduction
share or interest? If owned with someone other than spouse,
`,� indicate with whom
�y Yes 11 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:
yT, Real property ❑ Mobile home(IC 6-1-1-7)
district .[��////J�� ,/,�/ // ,�/�/ Key number I Legal description desccrriipptii000nn/�{S/� ,( �y!(((��-Record number Page number
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Is the property used and occupied primarily for Assessed value of the properly as of March 1,current year(may not exceed 5182,430
his/her residence? for Over 65 deduction,or 5160,000 for the Over 65 Circuit Breaker Credit)
❑ Yes ❑ No
Was the applicant 65 years of age or more on December 31 of the year
❑ Yes ❑ No
Have you filed for deductions in any other county? If Yes,what county?
❑ Yes ❑ 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 11F)Signature of applicant Address of applicant (number and street,city,state.and ZIP code)
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ature of authorized representative Address of authorized representative (number atfel street,city,state,and ZIP code)