Age_Montgomery ���"-!c. APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
7' :1--k, PROPERTY TAX BENEFITS a-CM
I
�;. State Form 43708(R13/4-15)
9,
saw-•�• 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 orpostmarlced by the following January 5.
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as real properly: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(please check all that apply) %i_
Over 65 Deduction from Assessed Valuation ❑ Over 65 Circ r edit .
9
pg
Name of applicant(owner or contract buyer)
a� O
Uoh F Mw we 0 ....., ., ...
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Is applicant the sole legal or equitable owner? No,what is hi er exact share or interest? If owned wit 'int f=-:r,„1„.
r-r�t���ommon,
indicate wit i,,:I'• vN-(
$Yes ❑ No SON CO
If name on record is differentl than that of applicant,indicate below Do all joint teeW or tenants in common reside on the property?
❑ Yes ❑ No
Name of contract seller Has applicant owned or been buying the property under recorded
contract 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 question:
dReal property ❑ Mobile home(IC 6-1-1-7) '
Taxing 'strict Key number/Legal description Record number Page number
KinetlYL 2k12-010•301}.Ddz•3oo-10zg
Does'applicant reside on property? Assessed value of the property as of current 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.)
Sig -ture of applicant Address of applicant (number and street,city,state,and Z de)
1 - '' . f IoN le, .ficiri 61-, gi nedip--4 , ,..iTti,-7bv
Sig -of authorized representative Address of authorized representative (number and street,city,state,and ZIP code)
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