Age_Davis (6) lit:
R,� APPLICATION
FOR
R SENIOR
CITIZEN COUNTY ��TOOWNtS/H�IP YEAR
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�l�[}��-yam,�� State Form 43708(R15/1-20) (j j b 5 s \--�F'^ D
'`\ ✓', Prescribed by the Department of Local Government Finance 'ro(ith'S hIP
File Mark
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9.
INSTRUCTIONS: To be filed in person or by mail with the County Auditor of the county where the property is located.
Filing Date: Form must be completed and signed by December 31 and filed
Type of benefit requested(Please check ll that apply)
aillOver 65 Deduction from Assessed Valuation 21<er 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer) ,
\Icxdev Lee Z--..,,,(1 %�av»
Is applicant the sole legal or equita le owner? If No,what is his/her exact share or interest? If owned with joint tenant or tenant in common,indicate with whom.
es CI No
Do all joint tenants or tenants in common reside on the property?
If name on record is different than that of applicant,indicate below. Yes ❑No
Name of contract seller Has applicant owned or been buying the property under re�co,rd�. contract for
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at least one(1)year before claiming deduction? 'Yes ❑No
I Is the property in question:
Address of contract seller(number and street,city,state,and ZIP code) lAiZeal property ❑Mobile home(IC 6-1-1-7)
Key number/Legal description I Record number I Page number
Taxing district
-p ,�00� (0,. �., 5h,sr a4-/a-/9- aoo - oo-o, t(33 _Oo�
Does applicant reside on property? Assessed value of the property as of current year assessment date(May not exceed$200,000 for Over 65 Deduction or$199,999
[The (counting just the
individual's spouse.)See reverse for details.
Have you filed for any other deductions? If Yes,what deductions? DEC 6 2022
Lgti �'
res ❑No 6J„I,,s,r
Have you filed for deductions in any other county?___
oouny?? If Yes,what county? ,//�
❑Yes Leo � 4
'c .el/ a.�'Y�c,Z'„l� }na
I/Ve certify under penalty of perjury that the above and foregoing information i
y(aPfaM fi)TY AUDITOR
/ , /�t� I Date(month,day,year)
Signature of applicant / �/ /� ���
CAddress f applicant (number and street,city,state,and ZIP code) �7� �� (//
33Y E ,-7pn 5 Pc Mtn['e_(t t'` J-J✓ Date(month,day,year)
Signature of authorized representative
Address of authorized representative (number and street,city,state,and ZIP code)
Date(month,day,year)
Signature of ounty Auditor / /a/ /apa
iy r�
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer
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