Age_Burger ay-3"of APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
e,4 : PROPERTY TAX BENEFITS ' E T
S �' State Form 43708(R13/4-15) li))
Prescribed by the Department of Local Government Finance -iLLJJ
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. APR 1 7.260 Mark
INSTRUCTIONS: To be filed in person or by mail with the County Auditor of the county where the properly
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Filing Dates: 1) Real Property:Form must be completed and signed by December 31 and filed or pos7Rfdh( }r-tt WN A
2) Mobile Homes assessed under IC 6-1.1-7 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. 812-7 '� S3- 4 0 Y .2—
Type of benefit requested(please check all that apply) ,�W,�
Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer)
Is applicant the sole legal or equitable owner? If No.what is his/her exact share or interest? If owned with joint tenant or tenant in common,
indicate with whom
Igi Yes ❑ 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 rying ree property under recorded
contract for at least one(1)year before claiming deduction?
Fl Yes ❑ No
Address of contract seller(number and street,city,state,and ZIP code) Is the property in question:
VReal property I 1 Mobile home(IC 6-1-1-7)
Taxing district Key number/Legal description I Record number Page number
34 t Aa-/9/?-30' -oao. io5-4 2.‘,
Does applicant reside on property?
•
Have you fled for any other deductions? If Yes,/what deductions?
.5(
Yes ❑ No /-T . 3
Have you filed for deductions in any other county? If Yes,what county?
❑ Yes No
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of applicant I Address of applicant (number and street,city,state,and ZIP code)
UA e,A.A. . �• )(507 F, 5nr/a .Sift 9t Aeolis,/ , +764-57
Signature of authorized representativ Address of authorized representative (number and street,city state,and ZIP code)