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1 APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
tea. PROPERTY TAX BENEFITS
r' - �• Slate Form 43708(R13/4-15)
Prescribed by the Department of Local Government Finance
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 aggJanuary 5.
2) Mobile Homes assessed under IC 61.1-7 or manufactured homes not assessed as real property 0 n-. 1w 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(please check all that apply) SEp
SL-Over 65
If owned with joint tenant or tenan��ttli1(
,,��,, � indicate with whom
L4'Yes ❑ No
If name on record is different than that of applicant,Indicate below Do all joint tenants or tenants in common reside on the property?
❑ Yes ❑ No
Name of contract seller Has applicant owned or been buying the property under recorded
contact for at least one(1)year before claiming deduction?
❑ Yes ❑ No
Address of contract seller(number and street city,state,and ZIP code) _ Is the property in uestion:
Real property ❑ Mobile home(IC 61-1-7)
Taxing district Key number I Legal desaiption Record number Page number
P Q_J0.M.) ala-ta-oS-Hoo- oco. y - oat
Does applicant reside on property? Assessed value of the property as of current year assessment date(may not exceed
5182,430 for Over 65 Deduction or$159,999(counting just the homestead site)for the Over
s ID No 65 Circuit Breaker Credit)
Signature of air
t Address of applicant (number and street city,state,and ZIP code)
/`yk/ ♦ � .,.�. .. 1?;31 c .—To + e_Jcs1/4_ I • '2c�.,
S•.. , of=, etytepreaerhtative Address of authorized representative ( tuber and stoet ate.state,end ZIP code)
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