Age_Forney •
4.(1A.o APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
"t:t PROPERTY TAX BENEFITS
� State Form 43708(R13/4-15)
�' • I. Prescribed by the Department of Local Government Finance ��
Sam •
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 requ sted( • ase check all that apply)
Over 65 Deduction from Assessed Valuatio ❑ Over 65 Circuit Breaker Credit
Name of applicant(owner o contract buyer)
Is applicant the sole legal ore itable own I o,what is hislher exact share or intbrest? If owned with joint tenant or tenant in common,
indicate with whom
Yes ❑ No ILED
If name on record is dill ent t n that of applicant,i icateF Do all joint tenants or tenants in common reside on the property?
NOV 0 6 2019 ❑'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?
El Yes ❑ No
•
Address of contract seller(number and street,city, fate'gig COUNTY AU D ITO Is the property in question:
Real property ❑ Mobile home(IC 6-1-1-7) '
Taxing district ey number/Legal description cord number Page number
Ala
2—o — -003 .410 -o2g
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 reverse for details.
Is the applicant 65 years of age or more on Decem er 31 o the year
Have you filed for any other deductions? If Yes,what deductions? ll
Yes \ \ tC O c1
El � � tHo f .
Have you filed for deductions in any other coup If Yes,what county?
❑ Yes No
IIWe certify under penalty of perjury that the above d foregoing information is true and correct. 1.
Signature of applicant Address of applicant (number and street,city state,and ZIP code)
K
5aci
Tact
Signature of authorized representative Address of authorized representative (number add street,city,state,and ZIP code)