Age_Cuzzort d<7 'e. APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR I
2:i ' PROPERTY TAX BENEFITS ti
-T'r' State Form 43708(R70/12-08)
Prescribed by the Department of Local Government Finance 1 1
_:�; i Fil- ark
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.1-35-9. •
INSTRUCTIONS: JUN 2 9 20i5
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 deducti. . to•be;v-_y!-.
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as real e :f' •� r!>7/!q 2)months
before March 31 of the year the deduction is to be effective. GIBSO• C UNT 13I 1 u�
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)
4-- c o &h G- o -
Is applicant the sole legal or equitable r? If No,what is his/her exact share or i If owned with someone other than spouse.
tete indicate with whom
Yes ❑ No
If name on record rr}'ecc1oorrd�iis 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�c seller(number and street,city,state,and ZIP code) Is the property in question:
❑(Real property ❑ Mobile home(IC 6-1-1-7)
Toxin tnct Key number/Legal description Record number 1 Page number
Ce Rip-l3-I /'f oy--OW. 3aY-
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 I I No
Was the applicant 65 years of age or more on December 31 of the year
❑ Yes s-No
Have you filed for deductions in any other county? If Yes,what county?
Yes ❑ No
IANe 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,statee,and ZIP code) —y� (�
Y. 0�2 vti� P'+ (^L /// 5- F. OI1-i.0 Ail 9i14:a4.E,I-•—QYti— 4 74 70
Signature of auto d representative Address of authorized representative (number and street,city,state,and ZIP code