Age_Sharp (2) •
-0'"'" APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
�•r-Nt"'_ PROPERTY TAX BENEFITS
„,::� wi.• State Form 43708(R13/4-15)
��tet. ' 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. I�II ,�nnnn be INSTRUCTIONS: ,� 1 it�/Y1I
To filed in /;NW a✓.
person or by mail with the County 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 .
betom March 31 of the year the deduction is to be effective. FILED
See reverse side for additional instructions and qualifications.
• Type of benefit requested(p/e so check a that apply)
Over 65 Deduction from AcePased Valuation VY Over 65 Circuit Breaker Credit./UN 1.4 2019
Name of applicant(/(oowneerr or contract buyer)
b -i- Je L no 31ar
(:IRSfIN CfIIINTY Al lfll R
Is applicant a sole legal or equl owneR If No, at is his/her exact share or Interest? If owned with Joint tenant or tenant in common,
indicate with whom
❑ No
If name on record is event nYes that of applicant,indicate below Do all joint tenants or tenants in common reside on the property?
❑ Yes ❑ No
Name of contras seller Has applicant owned or been buy./ the oroperty under recorded
contract for at least one(1)Year before chiming deduction?
Ill Yes El 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)
'axing district Key number/Legal description Record number Page number
Olaf /ft 26- 18-a7-lob-000 v-o2.
Does applicant reside on property? Aeenseed value of the pro rty asc of anent year aeanent date(may not exceed
65 Ch30for Over Gera) on or$159,999(counting just Ne homesteadsite/for the Over
Yes ❑ No Serrano Breaker Gera)
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 $ 0.00
Have you rued for any other deductions? If Yes,whatw deductions?u `
El9'1V1/iY'va
Yes No shDad
Have you filed for deductions in any other county? ribs,what county?
❑ Yes No •
I/We certify under penalty of perjury that the above and foregoing information is true and correct. '.
Sig lure of applicant
'pnt�y^1,`s` y��•Rom. (ly��y'-'�' Address`ss of applicantap (number//� and
sstmeet{'dfrtY.staatt`ae end ZIP code) ,r7/'� ft
l'Ci�.�syro/fir/iartura�u`.Faaed repmr taNe 1 Add !/VV r V ' `4✓--N 1! and street.ary.state,D auv I�✓!r 7.��5