Age_Fisher dl; . e APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
tk_- PROPERTY TAX BENEFITS
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State Form 43708(R73/4-15)
Prescribed by the Department of Local Government Finance
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Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. Nr. .10
INSTRUCTIONS:To be filed in person or by mail with the County Auditor of the county where the property is toted. 1�
Filing Dates: 1) Real Property:Form must be completed and signed by December 31 and filed or postmarked byrk\\\\following Jar ary 5,�OEL
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as real property:During the, ?�- \months
before March 31 of the year the deduction is to be effective. �'( r
See reverse side for additional instructions and qualifications. G0x3,
Type of benefit requested(please check all that apply) \�nN
Over 65 Deduction from Assessed Valuation ver 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer)
5� eve .fit �1c�er
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
'U 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 the property under 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:
❑ Real property ❑ Mobile home(IC 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
a(- 1a-gb-too-C&), %1-OQ'7
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?
❑ Yes ❑ No
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)
Atst . ,� �. ., x S.2 5, J
Signature of authorized representative Address of authorized representative (nu er and street,city,state,and ZIP code)