Age_Lytle • ' w APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
d- ` '.".:
' PROPERTY TAX BENEFITS
• State Form 43708(R14/10-17)
j ;'7 Prescribed by the Department of Local Government Finance
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. File Mark
INSTRUCTIONS: To be filed in person or by mad with the County Auditor of the county where the property is located.
fling Dates: 1) Real Property Form must be completed and signed by December 31 and filed or postmarked by the folbwhg January 5.
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as real properly:During the twelve(12)months
before March 31 of the year the deduction is to be effective.
See reverse side for additbnal insb ctions and qualifications.
Type of benefit requested(Please check at that apply)
®Over 65 Deduction from Assessed Valuation ®Over 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer)
Mayme Lytle
Is applicant the sole legal or equitable Amer? h No,what is his/bar exact share of interest? If owned with joint tenant or tenant in common.indicate with whom.
®Yes ❑No
If name on eox)is different than that of applicant,indicate below. Do all joint tenants or tenants in common reside on the property?
®Yes ❑No
Name of contract seller —( Hasa t mar been buying the property under recorded contract for
one panne deduction? ❑Yes ❑No
Address of contract seller(number and street,sty,state.and ZIP code) �e /..,,[[ Vets-At-
property in q'+Cir+on:
l Real property 0 Mobile home(IC 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
Center 26-13-28-200-000.420-004
Does applicant reside on property? Assessed value of the property as of current year assessment date(May not exceed$182.430 for Over 65 De5Wicn or$159,999
®Yes El No (�Seenreverse trng)usffor dthe homestead site)for the Over 65 CiYcua Breaker Corot.)
aBs.
Is the applicant 55 years of age or more on December 31 of the year Applicant's date of birth(month,day.year) If fled by a sunning,unmarried spouse,what was
prior to the year taxes are fast due and payable? ®Yes ❑No 07/17/39 the spouse's age at the time of death?
Adjusted Gross Income(AGI of applicant,applicant and spouse,or applicant Source of Income I Amount of Income
and joint tenants or tenants In common,as applicable(For Over 65 Deduction
AGI may not exceed 925 000 for the Over 55 Circuit Breaker Credit ACI may not $
exceed 530,000 for individuals or$40,000 for manietl couples).
See reverse for dates. FILED
TOTAL I $
Have you fled for any other deductions? If Yes.what deductions?
®Yes ❑No • Homestead JUN 112019
Have you riled for deductions in any other county? I It Yes.what county!
Dyes 0No
IiVM certify under penalty of perjury that the above and foregoing information iSGEE0$QgtjtJU N T Y./-,J J ITO R
Signature of applicant I Date(month.day,year)
XcVLCf �; ,, I G - -� - a?n/9
Address (number and street CrA a .and ZIP code)
2643 S E, Oakland City' N 47660
Signature of authorized representative - -_ Date(month day year)
Address at authorzed represematve (number and sheet,any,stale.and ZIP code)
I Signature of County Auditru 1 Date(month day year)
i
DISTRIBUTION: Original-County Auditor, File-Stamped Copy-Taxpayer