Age_Wirey .. "a APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
Y PROPERTY TAX BENEFITS
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\. �' State Form 43706(R73/4-15)
\ � Prescribed by the Department of Local Government Finance _ ,
. (- , Ap .
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9.
APR 6 2018
INSTRUCTIONS: To be tiled in person or by mail with the CountyAuditor 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 t y ollowin•,J-tei�- .
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as real pLaDp��y ••. ' • y(1;r1' ! 12)months
before March 31 of the year the deduction is to be effective. bIt1S"ON C•UNTY AUDITOR
See reverse side for additional instructions and qualifications.
Type of benefit requested(please check all that apply)
Ili Over 65 Deduction from Assessed Valuation `ll Over 65 Circuit Breaker Credit
Name of plicant(owner or contract buyer)
-
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Is app icant the sole I or epuita neR If No,what is his/her exact share or interest? if owned with joint tenant or tenant in common,
indicate with whom
❑ es ❑ 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 ID No
Name of contract seller Hasa applicant owned or been buying the property PP uy f P pnrty eduer 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:
1�4 Real property ❑ Mobile home(IC 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
1/0 J L,ok49-7" J -733-o6 -&Tao- coo i2/-ooh' .
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?
El Yes CI No
IN a 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)
Signatu of authorized representative Address of-uthorized representative (number and street,city,state,and ZIP code)