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c17-:- APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
\� PROPERTY TAX BENEFITS
�. State Form 43708(R13/4.15) S
iers 1 Prescribed by the Department of Local Government Finance
Gi .O�
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 CountyAuditor of the county where the property is located. •
Filing Dates: 1) Real Property:Form must be completed and signedby 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 instrut:tions and qualifications.
• Type of benefit requested(please check all that apply)
If name on record is different thanan that of applicant,indicate below Do all joint tenants or tenants in common reside on the property?
)2(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:
Real property ❑ Mobile home(IC 6-1-1-7) •
Taxing district
Key number/Legal description Record number Page number
Ujnoit
26-14-15-3130-000. 566'02S
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$15s s99(counting just the homestead site]for the Over
❑ No 65 Circuit Breaker Credit.)
esSee reverse for details.
Is the applicant 65 years of age or more on December 31 of the year
Have you filed for any other deductions? �` If Yes,what deductions?Shad
t.L�Yes CI No Shad/gil ti:',4,'V � .
Have you filed for deductions in any other county? If Yes,what county? g jl' 4
❑ Yes No
I/We certify under penalty of perjury that the above and foregoing information is true and correct. 1Q\I
Signature of applicanty_,
6. Address of applicant (number and street,city state,and ZIP coder OR
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2809 c ,_5I l!o re `jr�. , 14-Z6 &::.-
Signature of authorized representative Address of authorized representative (number and streefjcitistate,and ZIP code)