Age_Wira APPLICATION FOR SENIOR CITIZEN CO ;_ ,a • • WI•.�
PROPERTY TAX BENEFITS 1
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I. � State Form 43708(R13/4-15)I
Prescribed by the Department of Local Government Finance
i " il. , tTi
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. nn�`
INSTRUCTIONS:To be filed in person or by mail with the County Auditor of the county where the property is locatedBOT+rCOI A R
Filing Dates: 1) Real Property:Form must be completed and signed by December 31 and filed or postmarked'bby t e following January 5.
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as real property:During the 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)
Is applicant sole I I or equitable owner��hat is his/her exact share or interest? If owned with joint tenant or tenant in common,
indicate with whom
yYes ❑ 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 Hasa applicant pp owned or been b e the property under recorded
contract for at least one(1)year r before ore Gaiming deduction?
❑ Yes ❑ No
Address of contract seller(number and street,city,state,and ZIP code) Is the propert in question:
Real property ❑ Mobile home(IC 6-1-1-7)
Taxing dis t Key number/Legal description Record number Page number
year assessment date(may not exceed
5182,430 for Over 65 Deduction or 5159,999(counting just the homestead site]for the Over
❑ No 65 Circuit Breaker Credit.)
Yes See reverse for details.
Is the applicant 65 years of age or more on December 31 of the year
rte. Yes ID No H S
Have you filed for deductions in any other county?[[ If Yes,what county?
❑ Yes
I/We 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)
A14:7 C ��- 1 6a6Stoorad;T jre thonz representative Address of authori representative (number and street,city,state,and ZIP )