Age_Woolston I
•
., - APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR C�
• �i;:= PROPERTY TAX BENEFITS 97.st,in �'�� 1 l�l 1
• State Form 43708(R73/4-15)
s...�.�'.. Prescribed by the Department of Local Government Finance
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:Forn must be completed and signed by December 31 and filed or postmarked by the following January 5.
2) Mobile Homes assessed under IC 61.1-7 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 0that apply)L]f Over 65 Deduction from Assessed Valuation ❑ Over 65 Circuit Breaker Credit
Name ?tilt(otdfi/er\Y contract buyer) 0S�� 0 S-1:0 n
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 ❑ No
If name on record is di t than at of applicant,Indicate below Do all joint tenants or tenants in common reside on the property?
No
Name of contract seller FILED_ Has applicant owned or been the .0 Yes perry u O reded
contract for at least one(1)year airing tledvaroy?m
MAY 2 2019 es IXJ No
Address of contract seller(number and street,city,state,and ZIP code) Is the property in question: /\
• yA
i. ��•rUDITO Real property ElMobile home(IC 61-1-7)
Tatung district LMBSON I(eeld-c-•', R cord number 'Page number
pr •
�` a,(LCIS l3-l ogy -(j°1. V.- -C9-L
Does e'pficant reside on property? Assessed value of the propery as of anent Year assessment date(may nM exceed
$182430 for Over 65 Deduction or$159,999(counting just the homestead site)for the Over
❑ No 65 Unlit Breaker Caeca)
YesSee reverse for details.
Is the applicant 65 years of age or more on D m 31 of the year
Have you Wed for any other deductions? If Yes,what deductions?
❑ Yes ❑ No
Have you filed for deductions in any other county? XNo
Yes,what county?
❑ Yes I� No
l/We certify under penalty of perjury that the above and foregoing information is true and correct. ':
nature of applicant Address of applicant number and street,city'state,and ZIP code)
lArjeada
Signature of authorized presentative Address of authorized representative (nu Wit,cirri state,and ZIP code) `A 1 . :1 •.
