Age_Henson (2) „,i? APPUCATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
'Srit PROPERTY TAX BENEFITS
State Form 43708(R14/10-17)
Presets by the Department of Local Government Faience
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. File Mark
INSTRUCTIONS: To be fired in person or by mad with the County Auditor of the county where the property is located.
Fddng Dates: 1) Real Property:Form must be completed and signed by December 31 end tiled or postmarked by the following January 5.
2) Mobile Homes assessed under IC 61.1-7 or manufactured homes not assessed as real property:During the twelve(72)months
before March 31 of the year the deduction is to be effective.
See reverse side foraddd"onal instructions and qualifications.
Type of benefit requested(Reese check et that apply)
®Over 65 Deduction from Assessed Valuation ®Over 65 Circuit Breaker Credit
Name of appltant(owner orcontract buyer)
Ruth Adams Henson
Is applicant the sole legal or equitable owner? r No.what is his/her exact sham or interest? r owned with joint tenant or tenant Al common.indicate with whom
®Yes ONO
II name on record is different than that of apgicant indicate below. Do all joint tenants or tenants in common reside on the property?
®Yes ❑No
Name o mavact seder Has appFortt owned a been buying the property under recorded contract for
at east one(1)year before claiming deduction? Yes 'ONO
Address of contract seder(number and street cal(state,and ZIP code) Is the property in question:
®Real property 0 Mobile home(IC 67-1-7)
Taring district Key number/Legal description Record number Page number
Patoka Twnshp 26-03-35-100-000.859-027
Does applicant reside an property? Assessed value of the property as of anent year assessment daze tkay not exceed$192430 for Over 65 Deduction or 5159,999
®Yes ❑No S raegAist the
homestead site)
omesadsa)for sea Over 65 Circuit Breaker Credit)
Is the appricatd 65 years of age a most on December 31 of the year .
Source of Income Amount of Income
and join tea or tenants In cormnon,as appllcabb(For Over 65 Deluca ,
AG/may not exceed$25.000,'&the Over 65 Circuit Breaker Credt AG!may not Does Not File Taxes $
acted$30.000 fa individuals a 540000 for rimmed couples).
See mouse for Maas. $
TOTAL $ 0.00
Have you Bed for any other deductions? If Yes.what dedudms?
IYeS No Homestead
Have you Bed for deductions in any other minty? If Yes,what county?
Oyes ®No
wee certify tat penalty of perjury Mat the above and knowing information is true and carved. •
Signature oar •
(%�nm � I Dab( pdd ay year)
Address of applicant( end street city,sate end ZIP code) !(J"/ •// /
2025 N 825 W, Princeton, IN 47670
Signature of aahamw representative Date(motdh dal.year)
Address of authorized representative (number and street city.state,end DP code)
Signature of County Auditor Data(month.day.year)
DISTRIBUTION: Original•County Auditor, Flle-Stamped Copy-Taxpayer