Age_Chavis .r:+c. APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
PROPERTY TAX BENEFITS
State Form 43708(R13/4-15)
— Prescribed by the Department of Local Government Finance
File Mark
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9.
INSTRUCTIONS:To be filed in person or by mail with the CountyAuditor of the county where the property is located. /g
Filing Dates: 1) Real Property Form must be completed and signed by December 31 and filed or postmarked by th olo t fig nue 5.
6ri 2) Mobile Homes assessed under IC .1-7 or manufactured homes not assessed as real property During
before March 31 of the year the deduction is to be effective. !m
See reverse side for additional instructions and qualifications. MA y 1 r7
• Type of benefit requested(please check ell that apply) O 70�y
[ Over 65 Deduction from Assessed Valuation ❑ Over 65 Circuit Brey.st3 ''.` r1J'VNCD va 'ei
Name of applicant(owner or contract buyer) U TY AUDITOR
E('I e 5-k-N CJ S
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
L�Id'Yes ❑ No
If name on record is different than that of applicant,Indicate below Do all joint tenants or tenants in common reside on the property?
Efr< ❑ No
Name of contract seller Has applicant owned or been buying the property under recorded
contract for at least one(1)year before claiming deduction?
❑ 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 Key number/Legal description Record number Page number
C(\adkjekt <) atQ-IL-OS- 3CO- ooze 3t3-Oa7
Does applicant reside on property? Assessed value of the property as of current year assessment date(may not exceed
$182,430 for Over 65 Deduction or$159,999(counting just the homestead site)for the Over
Yes ❑ No 65 Circuit Breaker Credit)
See reverse for details.
Is the applicant 65 years of age or more on December 31 of the year
exceed$30,000 for individuals or$40,000 for married couples.). $
See reverse for details. TOTAL $ 0.00
Have you filed for any other deductions? ,—,/' If Yes,what deductions?
U✓ Yes El No
Have you filed for deductions in any other county? �� If Yes,what county?
❑ Yes I)d No •
IIWe 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)
-- 41-- ql5 A) SooW PrmettoyllAl 97/7D
Signature of authorized representative Address of authorized representative (number and street illy,state,end ZIP code)