Age_Burgerd�". ; APPLICATION FOR SENIOR CITIZEN
!= PROPERTY TAX BENEFITS
i, !e
Sta;e Form 43708 (R70 / 12-08)
•���O�l Prescnbed by the Department of local Gwemment Finance
Iniormation coniained in this document is CONFIDENTIAL pursuant to IC 6-1.1-72-9 and IC 6-1.1-35-9.
COUNTY
�
File
DEC 3 0 201!
INSTRUCTIONS:
To be �led in person or by mail wifh the CountyAudifor of fhe counry where the property is locafed.
Filing Oates: i) Real Property.' Dunng the hvelve (72) months belore December 37 of lhe year the�ded�sg� AL
2) Mobile Homes assessed under IC 6-1.1-7 or manu(aclu2d homes not assessed as real property: During fhe hvel
before March 31 0( Ihe year the deduction is to be eflective.
See reverse side for additional instructions and qualifications.
Type of beneft requested (please check all fhaf appty)
�Over 65 Deduction from Assessed Valuation �Over 65 Circuit Breaker Credit
Name of applicam (owner or wntract buyerJ
�
Is applicant the sol egal or equitable owner? If No, wh is his/her exact share or interest? If ov.•ned wiN someone oNer
indicate with whom
�Yes ❑ No
� If name on record is diYerent Nan that of appli�ant, indicate below
Name of mnvaU selier (applitant must have been buying on rontract af least one (7) year)
Address of wntract seller (numbe� and streef, city, sfate, and ZIP code) Is the pro0erty in question:
� Real property ❑ I
Tai disvict Key number / Legal tlescrip6on Record number
�� - .23-l7 _ aov-000_ /88-v �S�
Is the property used and occupied primanly for Assessed value of Ne property as of March 1, wrtent yea
his/her residence? Ior Over 65 deduction, ar S 760,000 /or the Over 65 Cirwi7
� Yes ❑ No
Was the applicant 65 years of age or more on December 37 of the year
was a resident
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