HomeMy WebLinkAboutAge_Mullican . *Of•k0 N. . .
•
'�'0"�a. APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
r�4 PROPERTY TAX BENEFITS
State Form 43708 R1314-15 � \
• ViVr\ 201C1
�' ieie' Prescribed by the Department of Local Government Finance V\
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 requested(please ck all that apply) (�
ver 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of applicant ner or contract buyer) inacli
A c
Is applicant the sole lega or equitab caner? If No,what is his/her exact share or interest? If owned with joint tenant or tenant in common,
indicate with whom
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?
es ❑ 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) la the property in question:
eal property ❑ Mobile home(IC 6-1-1-7)
Taxing dist'ct Key number I Legal description 1 , Record number Page number
1f '� p�iCj a-01 "ctoi -001 •koi ro
Does applicant reside on property?
Have you filed for any other deductions? If Yes,what deductions?
❑ Yes ❑ No
Have you filed for deductions in any other county? If Yes,what county?
❑ Yes .
I/We certify under penalty of perjury that the above and foregoing information is true and correct. x
_ Signature of applicant Address of applicant (number and street,city,state,and ZIP code)
...Fl Inte.144.<840.) tAlS S ‘thk(e. S4
Signature authorized representative Address of authorized representative (number and street,/y,state,end ZIP code)
r.