Age_Balbach ,Sw^1 iti S Cia
.. :t . APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
x'arn• PROPERTY TAX BENEFITS �• - I C�
State
Form 43708(P13/4-15)
—' eibed by the (R13Department of Local Government Fnarlce
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File Mark
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9.
INSTRUCTIONS:To be tiled in person or by mail with the CountyAuditor of the county where the property is located. -
Filing Dates: 1) Real Property:Form must be completed and signed by December 31 and tiled or postmarked by the following January 5.
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes
I1Name of applicant(owner or contract buye
Will t., .beck
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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 common,
indicate with whom
Yes ❑ No
If name on record is ewe t of applicant,�L E D Do all Joint tenants or tenants in common reside on the property?
❑ Yes ❑ No
Name of contract seller Has applicant owned or been theproperty under recorded
AU G 2 7 2019 contract for at leastone(1)year re wrung deduction?
Yes ❑ No
Address of contract seller(number and street city,state,and ZIP code) Is the p in question:
r Real property El home(IC 6-1-1-7)
a1RcpJy CO�� .
Tatung district K5um rlal yasUl rd number Page number
"3o1- ono . 6H1 -ooq
Does epplicart reside on property? Assessed value of the propecry as of anent year assessment date(may not exceed
$182,430 for Over 65 Deduction or$159,999(counting just the homestead site)for the Over
Yes ❑ No 65 Circuit Breaker Credit)
See reverse for details.
Is the applicant 65 years of age or more on D tuber of the year
Have you filed for any other deductions? ,,..1�,,�� \If t,what deductions
)(its ❑ No V) ,
Have you filed for deductions in any other county?,,,/// ��� If Yes.what county?
❑ Yes No
I/We certify under penalty of perjury that the above and regoing information is true and correct.
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Signature of applicant Address of appli t (number and t
nature of authorized representative Address of authorized repress umber and sheet,dty,date,and LP coda)