Age_Memmer I
e•"'"a APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
a . ` PROPERTY TAX BENEFITS
3\-•' r State Form 43708(R13/4-15)
\ � Prescribed by the Department of Local Government Finance 1_ t t '.
i J ` e7ark
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9.
MAR 6 2018
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 - foil°,7 :•::uary 5.
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as real pipped . ' g q- elve j2JQanths
before March 31 of the year the deduction is to be effective. GIBS NC J r ,,
See reverse side for additional instructions and qualifications.
Type of benefit requested(please check all that apply)
r 65 Deduction from Assessed Valuation IJ Over 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer)
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Is applicant the sole legal or equitable ovk[R . If No,what is his/her exact 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:
❑ Real property ❑ Mobile home(IC 6-1-1-7)
Taxing district I Key number/Legal description I Record number Page number
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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
65 Circuit Breaker Credit.)
❑ Yes ❑ NO
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
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 Address of applicant (numb/er and street,city,state,and ZIP code)
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$Igltature of authorized repres'y.=five Address of authorized representative (number and street,city,stare.and code)