Age_Fulling .i,1e: APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
t ^:s PROPERTY TAX BENEFITS
`. stion `Z-ol�
State 43708(R13/4-15)
lass State Formd by the (R13Department 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 Form must be completed and signed by December 31 and or postmark by the following January 5.
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not as s as real p p rty Durin. •: • •• a(12)months
before March 31 of the year the deduction is to be effective. M
See reverse side for additional instructions and qualifications. w W`(y
• Type of benefit requested(please check a9 that apply)
❑ Over 65 Deduction from Accrcced Valuation Over 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer)
Cayok S
Is applicant the sole legal or equitable owner? If No,what istuer exact share or interest? If owned with joint tenant or tenant in common,
indicate with whom
Yes 0 No
If name on record Is di t than of applicant,inchoate below Do all joint tenants or tenants in common de on the property?
II..., �i 'I) Yes 0 No
Name of contract sellergJ Has applicant owned or been buyln th m_ perty under recorded
contract for at least one(1)year ng deduction?
•
MAY 1 4 2019 ❑ yes ❑ No
Address of contract seller(number end street,city,state,and ZIP code) Is the p pe in question:
Real property ❑ Mobile home(IC 6-1-1-7)
Taxing district Key nu /s sh
radef'EYNITY AUDITOR rd number Page number
` N Zl-2°'-2-- -1uo- oo0-IS1 -lac
pr olppaemrt/y ceseppGcent reside ongmpertyl Assessed notexceed
$162,430 for ue of theOver 65 Deduction or S159,999 co as of current unting Just Nement d homate estead site)!w the Over
65 Circuit Breaker Credit)
❑ Yes ❑ No
See
,
exceed$30,000 for individuals or$40,000 for married couples.). $
See reverse for details. TOTAL $ 0.00
Have you fled for any other deductions? 1�f yes, t deductiooj?
IC J " J No S
Have you fled for deductions in any other county? \\\ � '� . If Yes.what county?
❑ Yes Id No
me certify under penalty of perjury that the above a d foregoing information is true and correct. t.
Sig�re of appl ant 7 Address of applicant (number end street city,state,and ZIP code)
xl - ictil E'� oos � 6J _ 3n 4 13
aturatura ofed representative Address of authorized representative (number and s�t city,state, P code)