HomeMy WebLinkAboutAge_Earley iosAN APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
[; PROPERTY TAX BENEFITS -
. r State Form 43708(R13/4-15) t9 '
% ;aye' Prescribed by the Department of Local Government Finance 1 v. o . ao
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 reque ed lease check all that apply)
Over 65 Deduction from Assessed Valuation ❑ Over 65 Circuit Breaker Credit
Name of applicant( ner ,cont t buyer) • - 1 1�c ;
�1� 'p ' ( �n� � t)
Oeti
0 corn � ��Is applicant the sol�'fe I ore itable owner? If Ns his/her exact shaest? If owned with joint tenant or tenant in common,
V indicate with whom
Yes ❑ No
If name on record is dill ent t n that of applicant,i Do all joint tenants or tenants in com on reside on the property?
F
es ❑ No
Name of contract seller Has applicant owned or been buyi t e roperty under recorded
•
OCT C T 3 0 2019 contract for at least one(1)year b fo c immg deduction?
. Yes ❑ No
Address of contract seller(number and street,city,state,and SIP code) Is the pr e in question:
O,BS N COUNTY AUDITOR eai property ❑ Mobile home(IC 6-1-1-7)
Taxing district Key number/Legal description Re rd number Page number
U— CI-2 —31,z"00D , Iss_o z6 .
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
❑ No 65 Circuit Breaker Credit.)
YesSee
❑ Yes A.lo
Me certify under penalty of perjury that the above and foregoing information is true and correct. P.
Signature of applicant Address of applicant (number a reet,cif'state,and ZIP code)
XS (M,,1, 1. f O (?0)9 -S-- E -3 _7.�^; Lt)
ignature of authorized representative 1I Address of authorized representative (number and reef,city,state,and ZIP code)
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