Age_McGregor :.. i APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
` ; PROPERTY TAX BENEFITS \ I/r p�
State Form 43738(R13/4-15) �V\ w\�h 1 n _1( 11G
Prescribed by the Department of Local Govemm ent Fnance `l ^—[`�J
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. - 12-? ' ( _ l(`-r I
Filing Dates: 1) Real Property:Form must be completed and signed by December 31 and filed orpostmar c.I by the follo^wtng 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 ase check ea that apply)
Over 65 Deduction from Assessed Valuation ❑ Over 65 Circuit Breaker Credit
Name of ap o er or contract
Is applicant sale legal or equit If No,what is er exact share or interest? If owned with Joint tenant or tenant In common,
indicate with whom
Yes ❑ No
If name on record Is dif lit that of applicant,Indicate below
a �'1 Do all joint tenants or tenants in common reside on the property?
FILE I,': ❑ Yes ❑ No
1
Name of contract saner Has applicant owned or been buying the property under recorded
comsat for at least one(1)year before claiming deduction?
mA' 102019 ❑ Yes El No
Address of contract saner(number and street city,slate,and LP a Is the pro
rty in question:
• ($Real property ❑ Mobile home(IC 6-1-1-7)
Taring a "s 3 cOf{}DITOR Re rd number Page number
G , 1c1 . 26-013 -30o-ono.tt2 7 - oo6
Does aDpIcent reside on property? Assessed value of the pm aso of current year assessment date(may rot exceed
$IBZ 430 for Over 65 De nor$159,999(mrmting just the homestead site)fir the Over
❑ No 65 Canut Breaker Owe)
❑ Yes See reverse for details.
Is the appflicant 65 years of age or more on December 31 of the year
$25,000;for the Over 65 Circuit Breaker Credit,income may not }
exceed$30,000 for individuals or$40,000 for married couples.). $
See reverse for details. TOTAL $ 0.00
Have you fried for any other deductions? OR what c . i
ductions?
yYes CI NR 1 QL -�
Have you filed for deductions in any other car If Yes,what county?111 i
L.
❑ Yes ❑ No
li% a certify under penalty of perjury that the above and foregoing information is true and correct. '.
Signature of applicant Address of applicant (number and street city,state,and ZIP code)
X ,u • y2je,a4r 010i L' ar S atitlan1 Ci-.- .n
Signature of authorized representative Address of authorized representative (number anysbeet.city sate,and ZIP code)
•
a APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR• i PROPERTY TAX BENEFITS 11 //�� �/�t�]
(--. 43 State Formby the -15) /ti1/_�r �( ,�111 nw�`c��U1-I
.y ias'� Prescribed by the Department of Local Government Finance \Gv'Jt\1_S W ML 1 `
•
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 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 requ ease check a0 that apply)
Over 65 Deduction from Assessed Valuation ❑ Over 65 Circuit Breaker Credit
Name of applicant contract buyeJr
Is applicant the sole I ••equitaf tdeo+mCer?ter^/ If N at• •r interest? If owned with joint tenant or tenant in common,
f� ip11 �ff I,\ indicate with whom
Yes ❑ No jf-.• i
If name on record is different than that of applicant,indicate below Do all joint tenants or tenants in common reside on the property?
MAY 10 2019 ❑ Yes ❑ No
Name of contract seller Has applicant owned or been bung the pproperty under recorded
contract for el least one(1)year before daimmg deduction?
�'�j'em ❑ Yes ❑ No
Address of contract seller(number and street city,state. 94)COU NTY AUD/TOR Is the property in question:
• Real property ❑ Mobile home(IC 6-1-1-7)
Taxis LStrict Key number/Legal description ecord number Page number
l s.q 26..... 13-13 3 0o O00 . it8 7 -Ord
Does applicant reside on property? Assessed value of the property as of anent year assessment date(may not exceed
65 Circ30 for Over 65dit.) on or$159,999(counting)usf the homestead site]roc the Over
❑ No 65 circuit Breaker crest)
❑ Yes See reverse for details.
Is the applicant 65 years of age or more on December 31 of the year
$25,000;for the Over 65 Circuit Breaker Credit, income may not
exceed$30,000 for individuals or$40,000 for married couples.). $
See reverse for details. TOTAL
L`���$ft 0.00
Have you feed for any other deduct ions? I If`Yes,what deductions? / �� ����1`
4Yes ❑ No N� '1
Have you filed for deductions in any other co II If Yes,what county?
❑ Yes fJJWo
I/We certify under penalty of perjury that the above andtforegoing information is true and correct. is
r \ $Ignature of applicant Address of applicant (number and street silkstate,and ZIP code)
\yt\/ � O h39 cc�5 , Q U
` -in
• ,_.
nature uthorized repress Address of authorized representative (number and street city,state.and ZIP code)