HomeMy WebLinkAboutAge_Christmas (2) .act.• APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
��. PROPERTY TAX BENEFITS l-\ �` , �C)��
State Form 43708(R73/4-15)
Prescribed by the Department of Local Government Finance •
File Mark
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-a
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)
Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name or applicant( contract buyer)
[AgA\\e. G OrMatinCtS -
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 digXn that of appfimnt,inNrate bit
�e B Do as joint tenants or tenants in common reside on the property?
F ❑ Yes ❑ No
Name of contract seller (� Has applicant owned or been buying the property under recorded
^v %VI contract for at least one(1)year before claiming deduction?
H1 ❑ Yes ❑ No
Address of contract seller(number and street city:state,and ZIP code) Is the property in question:
((��'1tyy COUNTY AVOtTOR `Real property ❑ Mobile home(IC 6-1-1-7)
Taxing district (jo) Mrtnber/Legal description R rd number Page number
Does applicant reside on property? Assn-ed value of the pmperty as of current year assessment date(may not exceed
r�r-`��yK
8182,430 for Over 65 Deduction or$159,999(counting Just the homestead site)for the Over
L es ❑ No 65 Circuit Breake for L)
See reverse for details.
Is the applicant 65 years of age or more on Decembe1 of the year
$ 0.00
Have you fled for any other deductions? )4Yes
If Yes,wh`atdeduct`iJns?
❑ NoH \�T4
Have you filed for deductions in any other coon I--\�C/,' If Yes,what
❑ Yes tit yvo •
I/We certify under penalty of perjury that the above/ and` foregoing information is true and correct. ?.
•
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Signature of applicant Address of applicant (number and street cty,state,end ZIP code)
A !4 ('�, -erg oc4 S� r"�ev)-3fl
Sisi store of authorized representative Address of authorized representative (number and street,d state.and ZlP code)