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ci,^�° ; ,� APPLICATION FOR SENIOR CITIZEN �" " couNTY�' WNSHI" YEAR
., ,:a PROPERTY TAX BENEFITS try
a ,t:_ `7
s State Form 43708(R13/4 15)•1.: `- ,� I2131
te ✓ie Prescribed by the Department of Local Government Finance �l\
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
.
• Type of benefit requested(please check all that apply)
IV Over 65 Deduction from Assessed Valuation ❑ Over 65 Circuit Breaker Credit
Name of applicant(o er ontract buyer)
• n 1.,_ 1,10_.• ��
Is applicant the sole legal• e r table owner?� If No,what is his/her exact share or interest? If owned with joint tenant or tenant in common,
indicate with whom
P Yes ❑ No
If name on record is diffe ent th that of applicant,indicate below Do all joint tenants or tenants in common reside on the property?
FILE �1 es CI No
Name of contract seller
Has applicant owned or been buyi •th •roperty under recorded
contract for at least one(1)year b- -c.iming deduction?
DEC 3 0 2019 AlYes ❑ No
Address of contract seller(number and street,city,state,and ZIP code) Is the property in question:
•
Gl��gqsn pI ' •�J ��/ Real property ElMobile home(IC 6-1-1-7) -
Taxingdistrict Key nnumberrLeg�dati T' AUDITOR cord number� Page number
ak' --� "VV• � t
Does applicant reside on property?
Yes ❑ No h \3 irk L_`!
Have you filed for deductions in any other county? If Yes,what county?
El Yes AD •
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Sign re of applicant Address of applicant (numb rand street,city,state,and ZIP code)
6 , VI' lit,
- 2
Signature of authonz€d representative Address of authorized representative (number and street city,state,and ZIP code)