Age_Matsel (2) k "o APPLICATION FOR SENIOR CITIZEN COUNTY I TOWNSHIP YEAR
PROPERTY TAX BENEFITS
State Form 43708(R13/4-15)
•
Prescribed by the Department of Local Government Finance FILED
File Mark
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. OCT
ZO,$
INSTRUCTIONS:To be filed in person or by mail with the County Auditor of the county where the property is 1p cated.
Filing Dates: 1) Real Property:Form must be completed and signed by December 31 and filed or postruhlla®r ving January 5.
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessrggis9ett4 ieelnaiir4Q41lWtQiVe(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(p ase check all that apply)
Over 65 Deduction from Assessed Valuation F Over 65 Circuit Breaker Credit
Name of applicant(owneroorrjccoonntraaccttbb�uyer) I1(/�I/�' Aid
D
ohs
' ` f ' v �hat is/1
Is applicant the sole legal or eq ble owner? If No,what 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 that of 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 been buying
u the property
pnrty under recorded
contract for at least one(1)year before claiming 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(IC 6-(-1-7)
Taxing district Key number/Legal description Record number Page number
696 -o 11- as- /0!- 000. ai0o -ai )
Does applicant reside on property? Accessed value of the property as of current year assessment date(may not exceed
S182,430 for Over 65 Deduction or S159,999(counting just the homestead site]for the Over
❑ Yes ❑ No 65 Circuit Breaker Credit)
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?
❑ Yes El No
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
natur pplicant Address of applicant (number and street,city,state,and ZIP code)
Signatur authorized a esentative Address of authorized representative (number and street,city,state.and ZIP code) (/ 24r /