HomeMy WebLinkAboutAge_Banet 1 C/ -'�A APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP I YEAR
0 PROPERTY TAX BENEFITS
3` State Form 43708(R13/4-15)
414 / Prescribed by the Department of Local Government Finance
File Mark
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9.
INSTRUCTIONS: To be fled 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 postma y e How g
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as real p rty�D ng / I t• ' months
before March 31 of the year the deduction is to be effective.
See reverse side for additional instructions and qualifications. MAR 2 0 2018
Type
1)year before claiming deduction?
❑ Yes ❑ No
Address of contract seller(number and skeet,city,state,and ZIP code) Is the property in estion:
Real property ❑ Mobile home(IC 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
cQ -LL-1 , -1o4-0co.•4Ql-cad . .
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 0 N
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 �jJ//jj Address of applicant (number and street,city,state,and ZIP code)
Signature of authorized representative Address of authorized representative (number and street,city,state,and ZIP code)