Age_Vantlin '4 APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
•
�• `'' PROPERTY TAX BENEFITS
::_.tic=
`� Sewn Form 43708(R13/4-15)
•' e a Prescribed
by the Department of Local Government Finance
40
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 Irk . ] D
Filing Dates: 1) Real Property:Form must be completed and signed by December 31 and filed or postma ed by the following January 5.
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as real property fjjingrthgh7�gp,(12)months .
before March 31 of the year the deduction is to be effective. ,J U L 1 L U 7
See reverse side for additional instructions and qualifications.
. A,
Type of benefitraquesred(please check all that apply)
lOver 65 Deduction from Assessed Valuation 2 Over 65 Circuit('8 1t�2�1})NTY AUDI OR
_ Name of applicant(ownerorcontmct buyer) _. _ _
by enr±a YvJ/ a
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 cannon,
,� indicate with whom
E(Yes ❑ No
If name on record its different than that of applicant,Indicate below Do all joint tenants or tenants in common reside on the property?
@rein& i of
Lnlei' es ❑ 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 seer(number and street,city,$fate,and ZIP code) Is the property in on:
•
Real property ❑ Mobile home(IC 6-1-1-7)
II Taxing district Key number I Legal description Record number Page number
•
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[co ntingJust the homestead site)for the Over
❑ No 65 Circuit Breaker Cat)
YesSee reverse for details.
Is the applicant 65 years of age or more on December 31 of the year Applicant's date of birth(month,day,year) If filed by a surviving.unmarried spouse,what
prior to the year taxes are first due and payable? was the spouse's age at the time of death?
Yes ❑ No
Adjusted gross income of applicant,applicant and spouse,or
$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 filed for any other deductions? �� If Yes,what deductions?CJ Yes ❑ No /WCn sf tic& $/V•
ariciayeJ
Have you filed for deductions in any other county? If Yes,what county? J
❑ Yes No
I/We 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,end ZIP code)
Signature of authorized renreeantativs Address of authorized representative (number and sheet,city,state,end ZIP code)
®t
0