Age_Stott . c
s_ • APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
PROPERTY TAX BENEFITS
_ State Form 43708(R13/4-15) ((((;;;; \` 1
Prescribed by the Department of Local Government Finance 51 y sw) I 01
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 located.
Filing Dates: 1) Real Property Form must be completed and signed by December31 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
before March 31 of the year the deduction is to be effective.
See reverse side for additional instructions and qualifications.
• Type of benefit requ ,ed(please check aS that apply)
Over 65 Deduction from Assessed Valuation ❑ Over 65 Circuit Breaker Credit
Name of applicant er contract buyer) `
Is applicant the sole legal or equitable If No,what is his/her exact share or interest? If owned with Joint tenant or tenant in common,
indicate with whom
❑ Yes No If name on record is darn-eat than that of appfuan 'n6cat owl L N Ttl ,
E D Do a9 joint tenants or tenants in common reside on the
AUG 2 1 2019 El Yes I�No
Name of contract seller Has applicant owned or been the property under.recorded
contact for at least one(1)year claiming deduction?
,�Jnl(///�,,�,,�, Yes ❑ No
Address of contract seer(number end street,dry,state and Z/9etN14)' Is the perry in question:
OIBSON COUNTY AUDITOR
Real property ❑ Mobile home(IC 6-1-1-7)
Taxing district Key number/Legal description rd number Page number
26 - k2?-G-) oo -oot , 6 j -ooL,
Does epplcant reside on property?
Have you filed for any other deductions? If Yes,what deductions?
A -
frs ElNo d for deducns In any other coun ))),,,___,,,/// If Yes,what county? — - --
❑ Yes L� No
UWe certify under penalty of perjury that the above and foregoing information is true and correct.
S' re of applicant Address of applicant (number end street,tity,state,and ZIP code)
l 2gul E Asp s f1 On -'
Signature of authorized representative Address of authorized representative (number end street city slate,end ZIP code)