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9 k APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP I YEAR
-4 = PROPERTY TAX BENEFITS
, State Form 43708(R13/4-15)
' Prescribed by the Department of Local Government Finance
CL
File Mark
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. i
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 the following January 5.
2) Mobile Homes assessed under IC 6-I.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 re ''ase check all that apply)
Dyer 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of applican ` contract buyer)
C ct L d- -dam L kc Uc & .
Is applicant the sole legal or 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 differ t th that of applicant,indicate below Do all joint tenants or tenants in co mo reside on the property?
Yes ❑ No
Name of contract seller Hasa applicant
pp owned or been buyith ropertyrecorded
under rnrded
contract for at least one(1)yearr before aiming deduction?
❑ Yes U No
Address of contract seller(number and street,city state,and ZIP code) Is the property in question:
Real property ❑ Mobile home(/C 6-1-1-7)
Taxing district Key number/Legal description R rd number Page number
(�kYli otek y' ab—\I 31 300 -9o3-S . 1 -- 0Z►
Does applicant e on property? Assessed value of the property as of current year ascsment date(may not exceed
5182,430 for Over 65 Deduction or$159,999/counting just the homestead site)for the Over
❑ NO 65 Circuit 8reakerCredit.)
es See reverse for details.
Is the applicant 65 years of age or more on DecePcof the year
Adjusted gross income of applicant,app 'cant and spouse, or Source of Income Amount of Income
applicant and joint tenants or tenants in common,as
applicable(For Over 65 Deduction, income may not exceed S
S25,000;for the Over 65 Circuit Breaker Credit, income may not
exceed S30,000 for individuals or S40,000 for married couples.). S
See reverse for details. TOTAL
�
AYes ElNo •
Z�Have you fled for deductions in any other coun Xlo
If Yes,what county?
ElYes
I/We certify under penalty of perjury that the above and foregoing information is true and corre D
Signature of applicant Address of applicant (number and street,city,state,and ZIP cog T 12 2018 �'rx
' nature of authorized representativeAddress of authorized representative (number and tog ' hit DITOR ��,