Age_Atchison 6 —viz —( z —3c9___- c QAy —02.6
' ; APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
• r' s PROPERTY TAX BENEFITS
_,. wIll.
,'P.:it t_/1 State Form 43708(Ri3/475) r� l 3,,^ h aol l A
.,. Prescribed by the Department of Local Government Finance `,t v , 1 l
File Mark
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.135-R
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 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 requested(please check e9 that apply)
Over 65 Deduction from Assessed Valuation CI Over 65 Circuit Breaker Credit
Name of applicant(owner or'Sonlract buyer)Is applicant the sole legal or a owneR ^ __II hid)
If No,what is Ns/her exact share or interest? If owned with joint tenant ar tenant In common,
Indicate with whom
❑ Yes 0 No
It name on record is different than that of applicant,indicate below jp J$.d,EL) Do all joint tenants or tenants in common reside on the property?
IIAtI Yes ❑ No
Name of contract sager APR 3 0 2019 Hasmnira nett l eo nl lo r ;edndue,red
❑ Yes ❑ No
Address of contract seller(number and street,city,state,and ZIP code) „ I„/ Is the pro
rty in question:
CIRSON COUNTY AUDITOR Beal property ❑ Mobile home(IC 6-1-1-7)
Tarring dusbia Key number/Legal description R rd number Page number
('t (0-11ciii a6-19-19-302-0(10. (X4 _cec
Does eppfirant reside on property? Assessed value of the pprrooppeertrtyy aso of anent year assessment date(may not exceed
Circuit
for Over 65 Deduct'on or j159,999(rormling just Ne homestead sle)for he Over❑ No 65 Grant Breaker Credit)
XtYes
See reverse for details.
Is the applicant 65 years of age or more on Deceof the year
Have you fled for any other deductions? If Yes,what deductions?
XYes El No ,No l i CL
Have you filed to deductions in any other county? If Yes,what county?
❑ Yes ❑ No •
INVe certify under penalty of perjury that the above and foregoing information is true and correct. is
•
Signature of applicant Address of applicant (nu nd street, slate,end ZIP code)
X 7 e !.:cit„;. � —tot E 7 cry;
{a,,,.k- &-r , P-1- 1-rArch-a 11-t-1j k2,
Signature of authorized representative Address of authorized representative (number and street.city state,end ZIP code)