Age_Lytle , ".'-'''9. APPLICATION FOR SENIOR CITIZEN
COUNTY TOWNSHIP YEAR
~4 • . PROPERTY TAX BENEFITS
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��. State Form 43708(R16/
' :: 1-23) 3p') Cad4- 70214
!' ' Prescribed by the Department of Local Government Finance
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 flied 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.
wer 65 Deduction from Assessed Valuation ver 65 Circuit Breaker Credit
N e of Applicant(owner or contract buyer) Telephone Number Email Address i
,r l ci,i L 1_.IL ( ) - -
Is Applicant the Legal Equitable Owner? If No.What is His/Her Exact Share or Interest? If Owned with Joint Tenant or Tenant in Common,Indicate with Whom
es � No 1
If Name on Record is Different than Applicant,Indicate Below Do All Joint Tenants or Tenants in Common R side on the Property?
es —1 No 1
Name of Contract Seller Has Applicant Owned or Bought the Property Under Recorded Contract for at Least-
One(1)Year before Claiming Deduction? . 'Yes 7-1 No
Address of Contract Seller(number and street.city. state.and ZIP code) Is t Property in Question.
Real Property Motile Home(IC 6-1.1-7)
Taxing District Key Number/Legal Description Record Number Page Number
0 DAL\ cukcLOJI*k-, .0. 0- 1--k - - 1---(0- - ( 0 _Go -o-u-/
Does Applicant Reside n Propert z Assessed value of the property as of current year assessment date(May not exceed$240,000 for Over 65 Deduction or
_ $199,999[counting just the homestead site)for the Over 65 Circuit Breaker Credit received before January 1.2020,and$199,999[al ,
es No _Indiana real property]for the Over 65 Circuit Breaker Credit initially applied for after December 31.2019)See reverse for details.
Have You Filed for Any Other Deductions? If Yes,W at Deductions?
Yes ❑No ` �� —-- —MAM-2-�, —
Have You Filed for Deduction in Any Other County? If Yes,What County? �uL��rl�,
0 Yes No yy,��� ' '`
l e certifyunder penaltyof perjury that the above and foregoing information is true and correct. N COI UDIT �R
GIBSO
P l rY 9 9 NTY AUDITOR
Signature of Applicant I Date(month. day.year)
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r :- as • . .L-t .
Address of Applicant(flambe nd street. y state.and ZIP code)
Signature of Authorized Representative r I Date(month.day.year)
Address of Authorized Representative(number and street.city,state,and ZIP code)
Signature of County Auditor ! l Date(month. day.IlLir\IV,Q-- JY\O`A--° 0- - \ r3Li—\ / "\C k 1-D . -- -ayear)
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer
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