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APPLICATION FOR SENIOR CITIZEN COUNTY1c TOWNSHIP YEAR
PROPERTY TAX BENEFITS ��ll�
State Form 43708(R13/4-15) ry 20
Presrnbed by the Department of Local Government Finance Vr� R' t
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 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 .
before March 31 of the year the deduction is to be effective.
See reverse side for additional instructions and qualifications.
Type of benefit requested ease check all that apply)
Over 65 Deduction from Assessed Valuation ❑ Over 65 Circuit Breaker Credit
Name of ap owner contract buyer) �� r '
6\i1� � I U ‘ n -
Is app t th { If No,what is h e ' erest? f If owned with joint tenant or tenant In common,
�J indicate with whom
❑ Yes No
gg� �
If name on record is different than that of ap 1,indicate below Do all joint tenants or tenants in common reside on the properly?
AUG 21 2019 Yes ❑ No
Name of contract sefier Has applicant owned w been buying the property under recorded
—� conbac fora leas one(1)Yea be(A
wedammgdeduWon?
GIBSO liNyyA Yes ❑ No
Address of contract seller(number and street city,state,and ZIP code) NTY AI/UITOR Is thepo rty in question:
• Real property 0 Mobile home(/C 61-1-7)
Taring district Key number/Legal description ecom number Page number
I IS)n 26 -1Z-ol- Lio3 - 002__°17L-o g .
Does eppfrcent reside on property? Assessed value of the property as of current year accaccmem date(may not exceed
Have you rued for any other deductions? If Yes,what deductions?
9(Yes ❑ No N\.S 'WU I
Have you fled for deductions in any other county?? It Yes,what county/
❑ Yes ❑ No •
IIWe certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of applicant Address of applicant (number and street.a ,state,and ZIP code)
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Signature of authorisedmprese Ad 514 S dress of authorized representative (number and street,city.state,and ZIP code) -.J