HomeMy WebLinkAboutAge_McCoy 47-----"`" . APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
b--. ' PROPERTY TAX BENEFITS
o 7 State Form 43708(R13/4-15)
•• ` Prescribed by the Department of Local Government Finance
p Vile Mark
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. 1�/J./ �
INSTRUCTIONS:To be filed in person or by mail with the County Auditor of the county where the property is located. II��xrtt
Filing Dates: 1) Real Property:Form must be completed and signed by December 31 and filed or postmarked by the folP vng.�nuary 5.
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.
Type of benefit requested(please check all that apply)
Over 65 Deduction from Assessed Valuation 2iver 65 Circuit Breaker Credit
Name of applicant(oowww/1nerr or contract buyer) (\�//,"���T/
Is applicant the sole legal or equitable If No,what is his/her ct share or interest? If owned with joint tenant or tenant in common,
indicate with whom
❑ 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 Has applicant owned or been buying the property under 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:
0 Real property ❑ Mobile home(IC 6-1-1-7)
Taxing dist' t Key number/Legal description Record number Page number
/2044i; a/a-010-ID3ct736o7oa
Does applicant reside on property? Assessed value of the property as arcurrent year assessment date(may not exceed
518Z430 for Over 65 Deduction or S159,999[counting just the homestead site]for the Over
D ❑ NO • 65 Circuit Breaker Credit.)
u Yes 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?
Yes ❑ No H-5
Have you tiled 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 Address of applicant (number and street,city,state,and ZIP code)c--- -c--,
S' nature of authod resentative Address of authorized representative (number anndstreet,city.state,and ZIP code)
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