HomeMy WebLinkAboutAge_Schmits (3) .�," ;APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
YI# a i PROPERTY TAX BENEFITS
s'r„� ,, State Form 43708(R16/1-23) "t ,S0 i1 Q Z sue_ 7-0�3
\`-Nar!/ Prescribed by the Department of Local Government Finance J •
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 with the county auditor or postmarked by the following
January 5 of the calendar year in which the property taxes are first due and payable.
See reverse side for additional instructions and qualifications.
Type of Benefit Requested(Please check II that apply)
Over 65
with Joint Tenant or Tenant in Common,Indicate with Whom
Yes a No
If Name on c rd is Different than Applicant,Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property?
❑ Y ❑ No
Name of Contract Seller Has Applicant Owned or Bought the Property nde ecorded Contract for at Least
One(1)Year before Claiming Deduction? ` Yes n No
Address of Contract Seller(number and street,city,state,and ZIP code) Is the
Property in Ou scion
Real Property E Mobile Home(IC 6-1.1-7)
Y i
Taxing District
$
Have You Filed for Any Ot r Deductions? If pf1Ih3DedUctions?
Yes ❑No F-14. 1)
Have You Filed for D du -on in Any Other C un . If Yes. hat County?
❑Yes No
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I/We certify under penalty of perjury that the bove and foregoing information is true and correct. 0�3
Signature f Applicant
i 049 month,day,year)
X ' �Nco Q
Address of Applicant(number and street,ci state,and ZIP code) ��
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Signature of Authorized Representative Date(month,day,year)
Address of Authorized Representative(number and street,city,state,and ZIP code)
Signature of County AIM �� Date(mont day. ar)
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DISTRIBUTION: Original—County Auditor; File-Stamped Copy—Taxpayer
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