Age_Robb (2) It APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
. PROPERTY TAX BENEFITS \ ((('��� /�I / State Form 43708(R13/4-15) [�` COvi � 201'1
•� is,." Prescribed by the Department of Local Government Finance �Jt L]
File Mark
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 CountyAuditor of the county where the property is located.
Filing Dates: 1) Real Property:Form must be completed and signed by Decemb- 31 and filed or postmarked by the following January 5.
2) Mobile Homes assessed under IC 6-1.1-7 orinanufactured ho - . sessed as real pDuring the twelve(12)months
before March 31 of the year the deduction is to be effective.
See reverse side for additional instructions and qualifications. •- l\
0
Type of benefit requested lease check all that apply)
I Over 65 Deduction from Assessed Valuation . ever 65 Circuit Breaker Credit
Name of apgliraet fawner or contract buyer)--1 utliM\ 'Rnn .
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 Ill No T� I
If name on record is different th n that of applicant,indicate belo Y JVJ E I Do all joint tenants or tenants in common reside on the property?
APR 2 2 2019 ❑ Yes ❑ No
Name of contract seller Hasa licant owned or been bu
ying rying the property under recorded
contract for at least one(1)year before claiming deduction?
,. Well EI Yes ❑ No
Address of contract seller(number and street,city,state,ano h'c & f f (-IOU'TY AUDITOR Is the property in question:
Real property ❑ Mobile home(IC 6-1-1-7)
Taxing district Key number/Legal description I Record number Page number
ab_12-1 S -102- 002 39t-u2 8
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$159,999(counting just the homestead site)for the Over
ElNO 65 Circuit Breaker Credit.)
XYes See reverse for details.
Is the applicant 65 years of age or more on December 31 of the year
Yes ❑ No I , \J A J riv o„s\11 eL .
Have you filed for deductions in any other county? If Yes,what county?
❑ Yes Lx No !
I/We certify under penalty of perjury that the above a d foregoing information is true and correct.
Signature of applicant Address of applicant (number and street,city state,and ZIP code
f a9— nun- st i\ 3\-\-
ure of authorized representative Address of authorized representative (number and street,city,state,and ZIP code)