Age_Armstrongd��"a APPLICATION FOR SENIOR CITIZEN
b ` PROPERTY TAX BENEFITS
S� � Slate Portn 43708 (R10 / 12-08)
•'��� �, Prescnbed by the Department of Local Govemment Finance
Infortnation contained in this document is CONFIDENTIAL pursuant ro IC 6-7.1-12-9 and IC 6-1.7-35-9.
INSTRUCTIONS:
To be �led in person or by mail wi(h the CountyAuditor of the county where the pmperty is located.
Filing Dates: 7J Real Property: Dunng the Rvelve (72J months 6e(ore December 37 07 the year the dedg
2) Mobile Homes assessed under IC 6-7J-7 or manufactured homes not assessed as real
before Maroh 37 0/ the year the deduclion is to be eRecWe.
See reverse side for additional inshuctions and qualifications.
7ype of beneft requested (please check all that apply)
�, Over 65 Deduction from Assessed Valuation
Name of {�p lirant (owner a contract buyerJ
COUNTY TOWNSHIP YEAR
� I
File ar
DEC 2 9 2015
t$� i
vperty: unUiNtTi�t�IDI(►ORonths
� Over 65 Circuit Breaker Credit
Is applipnt Ne 5ole I�al or equitable owner? If No, what is his/h act share or interest? IF owned with someone oNer
indicate with whom
� Yes ❑ No I
If name on record is diRerent than ihat of applicant, indicate below
Name of con;ract seller (applicant musf have been buying on contraU a!leas! one (7) year)
AEdress of convact seller (number and streef, city, sfafe, and ZIP code) Is the pmperty in question:
❑ Real property ❑
Taaing distric� Key number I Legal description Record num6er
a(o -17-/a-�Oy oo� 9sa_o�/
Is Ne property u and ocwpied pr' nly for Assessed value of Ne proDerty as of MarU 1, wrtent y�
his/her residence? lor Over 65 deduc(ion, or 5760.000 7or fhe Over 65 Gm�
I �,Yes ❑ No
Was Ne applicant 65 years of age or more on December 31 of the year
prior ro Ne year taxes are first tlue and payable?
� Yes ❑ No
Adjusted gross income of applicant, spouse, and any
individuals sharing ownership (For Over 65 deduction, income
may nof exceed S25,000; for the Over 65 Circuit Breaker Credit,
income may not exceed 530,000 /or individuals, or 540, 000 for
manied couples).
Have you (ded for any other deductions?
� Yes ❑ No
Have you filed for deducfions in any olher wunry?
❑ Yes ;� No
was a resident