Age_Maglinger "oz APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
e—.- = PROPERTY TAX BENEFITS
S\'•` i State Form by 43708
the epa t 4-15)
\ � Prescribed by the Department of Local Government Finance
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9.
O`/� ` - .'
INSTRUCTIONS: To be filed in person or by mail with the CountyAuditor of the county where the property is located. j v 20p
Filing Dates: 1) Real Property::Form must be completed and signed by December 31 and filed or postmarkerlbcyrr�yt wing anus 5.
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as real grope Ptlucirtg nths
before March 31 of the year the deduction is to be effective. NTy 4t/n
See reverse side for additional instructions and qualifications. R
Type of benefit requested ease check all that apply)
Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of a licant(owner or contract buyer --,, '' '' / \•
Name
/L7 x/�� /��//�� / - .
Is applicant the sole legal or equitable owner? If No,what is hl9per exact shit"interest? If owned with joint tenant or tenant in common,
!((C, 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?
LJ 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:
�/I Real property ❑ Mobile home(IC 6-1-1-7)
X
Taxin district Key number/Legal description Record number Page number
l/XOiLX o7n /?/off—/O�—DOD. l0 33 —O�a
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
ill N0 65 Circuit Breaker Credit)
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?
XYes ❑ No y�
Have you filed for deductions in any other county? If Yes, hat county?
❑ Yes X No ly lj,K) o
Ime certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of applicants Address of applicant (number and street,city,state,and ZIP code)
1),�-'.i i/ �.rr;.677 J X lv/O r • 727-el-C-2: ( .� .. �71v 6�
Signature of authorized representative Address of authorized representative (number and street,city,state,and ZIP code)