Age_Bree 01,4 . APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
g PROPERTY TAX BENEFITS
State Form 43708(R13/4-15)
+` isu • 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 CounfyAuditor 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.
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See reverse side for additional instructions and qualifications.
• Type of benefit requested(please check all that apply)
ver 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of
applicant(owner or contract buyer)ap
Is applicant the sole legal or equitable owner? 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?
OFCLod'Yes ❑ No
Name of contract seller Has applicant owned or been buying the property under recordgd
contract for at least one(1)year before,,claiming deduction?
Glesnn �0/9 at-VI; ❑ No
Address of contract seller(number and street,city,state,and ZIP cog G,O Is the property in question:
u
IV)), Real property ❑ Mobile home(IC 6-1-1-7) •
Taxing district Key number I Legal description Obi? Record number Page number
oaa, C �Q- l I--q •2 ( -7/o- 001
Does applicant reside on property? Assessed value of the property as of current year assessment date(may not exceed
$162,430 for Over 65 Deduction or$159,999[counting Just the homestead site)for the Over
Yes El NO 65 Circuit Breaker Credit)
Kfice; ❑ No
Have you filed for deductions in any other county? If Yes,what county?
❑ Yes Lld'No
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
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Signet f a plicant Address of applicant (number and street,city state,and ZIP code)
Si re of authorized representative Address of authorized representative (number and street,ci e,and ZIP code)
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