No preview available
Age_Garrett (2) `"'" APPLICATION FOR SENIOR CITIZEN s�� - a� COUNTY TOWNSHIP YEAR PROPERTY TAX BENEFITS 2 � � State Form 43708(R16/1-23) \ In o� CA _i• Prescribed by the Department of Local Government Finance Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. INSTRUCTIONS: To be filed in person or by mail with the county auditor of the county where the property is located. Filing Date: Form must be completed and signed by December 31 and filed with the county auditor or postmarked by the following January 5 of the calendar year in which the property Name of Applicant(ow er or cont ct bu r) Telephone Number Erna' ddress _ Vi( c Is Applicant the Sol L I Vlor Equitable Owner? 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 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 Bought the Property Under R ed 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 Q estio Real Property ❑ Mobile Home(IC 6-1.1-7) Taxing District �I Key Number/Legal Description Record Number Page Number It 2,6 _ 1-)- 19-2oo-coo . Ct6 --02l Does Applicant Reside on Property? Assessed value of the property as of current year assessment date(May not texceed$240,000 for Over 65 Deduction or $199,999(counting just the homestead site]for the Over 65 Circuit Breaker Credit received before January 1,2020,and$199,999(al Yes ❑ No Indiana real property]for the $ Have You Filed for Any Oth Deductions? If Y h Deductions? - 1,,tb Yes ❑No (/ Have You Filed for duc n in Any Other oun If Yes, hat County? ✓O ❑Yes No J4 I/W 9e certify under penalty of perjury hat the above and foregoing information is true and correct. Gf 20�I Signa5ure of Applicant Jl _ rtAitettqd3sar) Address of Applica t(number and street,city,stte,and ZIP code) T Y�Ulf 1 �- 62 go o s � 1 v;\1 c - 5n _ Signature of Authorized Representative Date(month,day,year) Address of Authorized Representative(number and street,city,state,and ZIP code) Signature of County Auditory Date(mq d ,ye ram) r DISTRIBUTION: Original—County Auditor; File-Stamped Copy—Taxpayer