Age_Chandler (2) "" APPLICATION FOR SENIOR CITIZEN COUNTY ! TOWNSHIP YEAR
ts- f PROPERTY TAX BENEFITS
�` r State Form 43708 Department FILE
‘lio Prescribed by the Department of Local Government Finance
File Mark
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. MAR 6 2017
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' �'r�"
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as real prop61j3SONgooldN7ROWEIROR
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 all that apply)
Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of applicant(owner or
what is his/her exact share or interest? If owned with joint tenant or tenant in common,
indicate with whom
❑ Yes El No
If name on record is different than that of applicant,indicate below Do all joint tenants or tenants in common reside on the property?
❑ Yes ❑ No
Name of contract seller Hasa applicant owned or been buying the property pp yi f p pngy educt recorded
contract for at least one(1)year before claiming deduction?
❑ Yes ❑ No
Address of contract seller(number and street,city,state,and ZIP code) Is the property in question:
❑ Real property ❑ Mobile home(IC 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
CACLAVoo-r—' p7(o„A0 — 3(0—300 — coo. 8 70 - , o
Does applicant reside on property? Assessed value of the property as of current year assessment date(may not exceed
�/ 5182,430 for Over 65 Deduction or 5159,999[counting just the homestead site)for the Over
/,� Yes ❑
No 65 Circuit Breaker Credit.)
See reverse for details.
Is the applicant 65 years of age or more on December 31 of the year
Have you filed for any other deductions? If Yes,what deductions?
N. Yes ❑ No /T S °/ It7t9
Have you filed for deductions in any other county? If Yes,what county?
❑ Yes I No
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of applicant Address of applicant (number and street,city,state,a ZIP code)
—t' Y4 /o5( 2_ / oso -
isi Signature of authorized representative Address of authorized representative (number and street,city state,and ZIP code)