Age_Hooker (2) ate APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
�i_— - - PROPERTY TAX BENEFITS /) `
e-- State Form 43708(R73/4-15) r 5s� P '( 4/ ` �`�
Prescribed by the Department of Local Government Finance -
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 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 6-1.1-7 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 requested(please check all that apply)
I Over 65 Deduction from Assessed Valuation ❑ Over 65 Circuit Breaker Credit
Name of plicant(owner or contract buyer)
T \JtkeA
Is applican 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
It name on record is different than that of applicant,indicate below Do all joint tenants or tenants in common reside on the property?
i ' 3
FILE ❑ Yes ❑ No
Name of contract seller I Has applicant owned or been buying the property under recorded
contract for at least one(1)year be` re aiming deduction?
APR 2 9 2019 $ 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 I Key numbP t3-dWasc.OLJITY AUDITOR Record number Page number
Does applicant reside on property? Accessed 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
es ❑ No 65 Circuit Breaker Credit.)
See reverse for details. TOTAL $ 0.00
Have you filed for any other deductions? If Yes,what deductions?
Yes ❑ No H,w ?
d i VI CiCtbi3
Have you filed for deductions in any other coon, If Yes,what county? Nr •
❑ Yes No
I/We certify under penalty of perjury that the above an oregoing information is true and correct.
Signature of applicant Address of applicant (number and street,city,state,and ZIP code)
Signature of authoriz epresentative Address of authorized representative (number and street,city,state,and ZIP code)