HomeMy WebLinkAboutAge_Askren�^'°-'"o APPLICATION FOR SENIOR CITIZEN
r°b _� � PROPERTY TAX BENEFITS
�r SHte Form d3708 (R10 / 12-08)
� a�. Prescdbed by the Department of Local Govemment Finance
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-7.1-35-9.
COUNTY TOWNSHIP YEAR �
I� I
i e ark
DEC 2 2 2015
INSTRUCTIONS:
To be (led in person or by mail with the CountyAuditor o71he county where the property is located. ,
Filing Dates: iJ Real Property: Dunng the twelve (72J months 6e%re December 31 0/ the year lhe deductiol�(g�
2) Mo6i/e Homes assessed unde� IC 6-7.1-7 or manufactured homes not assessed asf3iBaQ�+Cy416N�:h��) months
before March 37 0/ the year the deduction is to be e(/eclive.
See reverse side for additional instructions and qualilications.
Type of beneft requested (please check all fhaf apply) I
� Over 65 Deduclion from Assessed Valuation �Over 65 Circuit Breaker Credit
Name of applirant (owner or contract buy�J I
�/ ����<2-1�/�-C/ri/
�
Is appliwnt Ihe sole legal or equifable owne� If No, what is hisRier exact share or interest7 If owned vrifh someone oNer than spouse,
indica:e with whom
Yes ❑ No
If name on recortl is diRerent than that of applicam, intlicate Oelow
Name of conVact seller (appliwnf must have been buying on connacf at leasf one (7J year)
Address of conVacl seller (numbe� and sf2et ciry, sfate, and ZlPCOde) Is the propeny in question:
❑ Real property ❑ Mobile home (IC 6-1-7-n
Tazi stricl Key number / Legal description Record number Page number
�a�o-�� �r�ur� 6 - � �t - .� Y- .3 d 3 -Oo o . .3 � - 01- o
Is the propeny used and occupied primarily for Assessed value of the property as of Ma¢h 1, curtent year (may not exceed 5f82,430
his/her residence? 1orOver 65 deducfion, or 5160,000 forthe Over 65 Cilcuit &eakerCrediq
�Yes ❑ No
Was the applicant 65 years of age or more on December 31 of the year
Have you fled tor any olher Oeductions? �� Yes, what deductions? I
(�1 Yes ❑ No � S
Have you filetl fw deductions in any other wunry? If Yes, what county?
❑ Yes ❑ No
IIWe certify under penaliy of perjury lhal the above and foregoing information is true and correct and that the applicant was a resident I
of Indiana and owner of ihe aforementioned property on March 1, 20 _
gnature ot aDPlicani l Address of applicant (num6er and s(reef, uty, state, antl ZIP code)
�.�GC., I\ , C���CVI �' Z vT I'�9CK s�: i� 0 A LNC� ,�? lC Ul��
Signature of a rized representative Address of authonzed represenlative (numberand sfreef, ciry. s afe, erM ZIP code)