Age_Douglas • "a APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP I YEAR b— PROPERTY TAX BENEFITS St3 State Form 43708(R13/4-15) 6p Prescribed by the Department of Local Government Finance FILED FilU Mark Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. FEB 9 L M INSTRUCTIONS: To be filed in person or by mail with the County Auditor of the county where the property is located. c Filing Dates: 1) Real Property:Form must be completed and signed by December 31 and filed or postmarked AUnw g,//ar�u�gT0f2 2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as real Pik/During Othe 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) [X Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit Name of applicant(owner or contract buyer) lQo.t,kid ford If No. 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 NI—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: Real property ❑ Mobile home(IC 6-1-1-7) Taxing district Key number/Legal description Record number Page number ( t ,/EJt LIC c. 4.4)5- 5g 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 No Circuit Breaker Credit.) ❑ YES ❑ Have you filed for any other deductions? If Yes,what deductions? Yes ❑ No y-5/, Have you filed for deductions in any other county? If Yes!What coup ❑ Yes 114 No IMe certify under penalty of perjury that the above and foregoing information is true and correct. n Sigrletu of appli Address of apph ty�umber and street,ply,Mate,and ZIP code) �( u� k- / lekA /N '/q&½ Signature of a thorized repres t Address of authorized representative (number and street,city,state,and ZIP code) ",;