Age_Fichter •
a APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
�.4;:. PROPERTY TAX BENEFITS
': ',_ Slate Form 43708(R73/4-15) �n D lip �okq
•1 e;.�•. Prescribed by the Department of Local Government Finance ` 11"1V1\ "11
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 Dates: 1) Real Property:Form must be completed and signed by December 31 and filed or postmarked by the following January 5.
2) Mobile Homes assessed under IC 61.1-7 or manufactured homes not assessed as real property:During the twelve(12)months
before March 31 of the year the deduction is to be effective.
See reverse side for additional instructions and qualifications.
Type of benefit requested((please check a0 that apply)
Over 65 Deduction from Assessed Valuation 1 ❑ Over 65 Circuit Breaker Credit
Name of applicant(or-
J contractbuyer) 1
Is applicant the sole legal or equitable owner?E `,,,`rIJVV-tIIff N"`o,what is his/her exact share or interest? If owned with Joint tenant or tenant in common,
�(., indirare with whom
I)iJ Yes ❑ No r�
If name on record b cfrif �/t 1Wn that of Tit beED Do all joint tenants or tenants in common reside on dw property?
❑ Yes ❑ No
Name of contact seller MAY 3 201S cHoanst aapcpt oar nat weo nore(be)e yne buying
o th
re ed ppairompengrtyd uendue onreoed
❑ Yes ❑ No
•
Address of contract seller(number and street,dry,sta and ZIP _ Is the pro in question:
GlBSOH COUNTY AUDITOR Real property ❑ Mobile home(/C 61-1-7)
Taxing district Key number I Legal description JJJJJJ7JJ7�[[AARAAA��ttmmmmmnrd number Page number
9- 1�Sw a6-1)'.-OR-1ko-ona c3-023.
Does applicant reside property? Assessed value of theproperty aso of current year asgpgsment date(may not exceed
Circuit
30 far Over 65 Deduction ar$159,999/canting just the homesteadsite)for rile Over
❑ No 65(xauit Breaker r t.)
Yes See reverse for details.
Is the applicant 65 years of age or more on December 31 of the year
Adjusted gross income of applicant,apppplicant and spouse,or
—
exceed$30,000 for individuals or$40,000 for married couples.). $
See reverse for details. TOTAL $ 0.00
Have you grad for any other eduction? If Yes,what deductions? (II I('�--^
�d Yes ❑ No H �.. f or -
tineyou filed for deductions in any other court I,Yes;what county'! <' •
❑ Yes No
Th
IIWe certify under penalty of perjury that the above and foregoing information is true and corre.:r.
VVS.nature of applicant Address ofapplicant (number and stree talk slate,and ZIP e)
) i 're�aa E�A Address S\ O E v \ state. -o\-9*63c
.w, . d
AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, couNrr TOWNSHIP rEart
REQUESTING DEDUCTION FROM ASSESSED VALUATION
�> �w ! State Form 43708 (R7 / SOB)
Presmbed bY tt�e Oepart�rnt W Loral Govemmeni Finance
File
�ation conGined in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.135-9.
INSTRU,CTIONS: FILING DATES: OC� � � ���I%
To be (led in person or by mail with the County Auditor ot the counry where 1) Real property: Dunng he 2 m t s be;ore June
the property is located. f i of the year the deduction is to be eRective.
2) Mobile homes ass� I,�,,�y�,. 6-1-1-7;
See reverse side lor additional instruction and qualifications. behveen Janu_a7 1,5, a�MarchCdl ot the year
the deducti��s�b����eAUDITOF �
�
� f
i
applicant the sde legal or ��
name on record is
P�PeAY use
r residence?
Yes ❑No
(appllcant must have been
/ � ' � `
���u
�, what is hislher exaq share w
on conhact at �east one
_.. �_.
-/� -U - dZJ -O� 3.
oa;
fw � Assessed value oi
exceed 8144,000J
VYas Me applicant 65 years of age w rtrore o�
priw to �he current year7
ed by a survrving, unmamed spouse, what was
tlme of death?
re you filed fw any other deducUOns?
you filed fw deductions in any other
❑Yes ❑No
�.mbec3� oi the year
DYes ❑No
ise's age
I with someone other Nan spouse,
wiUi whom
propeAy in question: �
�Real property ❑ Mobile home (I.C. 6-14-n
�ecord number Page number
as
_
❑Yes ❑No I
I/We certify under penalty oi perjury that the above and foregoing infcu**��+��n is Vue and correc[ and thai the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
��� ���
ress ot applipnt
74 5 - /$D E
aR►Nce-ro,v. r�vD �f �
�
of authorized representative
author¢ed representative