Age_Wehmerd�^�"v APPLICATION FOR SENIOR CITIZEN
-E �. ` PROPERTY TAX BENEFITS
i•" �
r SWte Form 43708 (R70 / 72-08)
•� :�� � Prescribed by the Depanmem of Local Govemment Finance
Iniormation contained in this document is CONFIDENTIAL pursuani to IC 6-1.7-72-9 and IC 6-1.1-35-9.
r
COUNTY TOK'NSHIP
1 �I�
DEC � 5 2015
INSTRUCTIONS:
To be (led in person or by mail wifh !he CountyAuditor ot the county where the property is located.
Filing Dafes: 7J Real Property: Dunng the Rvelve (72J months be%re December 31 0/ lhe year the deduction ��g �
2) Mobile Homes assessed under IC 6-7. L7 or manulactured homes not assessed as real property: Dudng
be(ore Maroh 37 0/ the year the deduction is to be e8ective.
See reverse side 7or additional instructions and qualifications.
Type of benefit requesled (please check all fhat applY) ,�,(
1C1 Over 65 Deduction from Assessed Valuation ITl Over 65 Circuit Breaker Credit
/� ��
IName of appli�t (owner a conbact buyer)
Is applicanTiFe wle legal or equitable owne/?` If No, what is hislher ezact share or interest?
❑ Yes ❑ No
If name on record is di°erent ihan that of appliwnt, indicate below
Name of contract seller (app/icant musl have been buying on contract af /east one ry) year)
Atldress ot convaci seller (number antl s7reet, uty, stafe, and ZIP code)
Taxing
and occupied
Key number / Legal description
❑ Yes ❑ No
Was the apP���nt 65 years of age or more on December 31 of the year
pnor to Ne year tazes are first due and payable?
❑ Yes ❑ No
Adjusted gross income of applicant, spouse, and any
individuals sharing ownership (ForOver 65 deduction, income
may not exceed 525,000; /o� the Over 65 Circuit Breaker Credit,
income may not exceed 530, 000 (or individua/s, or 540,000 for
manied couples).
Have you filed for any other deductions?
Yes
Have yw filed for Ee�uctions in any other wunty?
❑ Yes
❑ No
❑ No
If ovmed vriN someone
indicate with whom
Is the property in question:
❑ Real property ❑
Recortl number
Pssessetl value of the pmperty as of March 7, wrreni yea
for Over 65 deducfion, or 5760.000 lor the Over 65 Grcuit
Applicanfs date oF birth (monlh, day, yearJ If filed by
what was
of death?
was a resident
0