Age_Landis C
`tea. APPLICATION FOR SENIOR CITIZENCOUNTY TOWNSHIP YEAR
L `� PROPERTY TAX BENEFITS
J State Form 43708(R13/4 15)• Ti" 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 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 instructions and qualifications.
• Type of benefit requ ted ' ase check all that apply)
Over 65 Deduction from Assessed Valuation ❑ Over 65 Circuit Breaker Credit
Name of applicant(owner or ntract buyer)
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Is applicant the so al or ' ble ow r? No,what i his/her x share or interest? If owned with joint tenant or tenant in common,
indicate with whom
Yes ❑ No
If name on record is diff ent an that of applicant,indicate below Ei Do all joint tenants or tenants in common reside on the property?
i ILYes ❑ No
Name of contract seller Has applicant owned or been buyi t roperty under recorded
ZUZ� contract for at least one(1)year be re iming deduction?
FEB Yes ❑ No
Address of contract seller(number and street,city,state,and ZIP code) -./ Is the property in question:
J' nt INTY AUDITOR Real property El Mobile home(IC 6-1-1-7) •
Taxing district Key nuQNal gebtrffotion R rd number Page number
•
Q 2 C0 -s12-pi 2\4-ooz .SI)1 c-5-4 .
Does'ijjplicant reside on property? Assessed value of the propperty as of current year assessment date(may not exceed
$182,430 for Over 65 Deduction or$159,999(counting Just the homestead sifej for the Over
❑ No 65 Circuit Breaker Credit.)
YesSee reverse for details.
Is the applicant 65 years of age or more on De mber 1 of the year
Have you filed for any other deductions? If Yes,what deductions?
Have you filed for deductions in any other cou ty? If Yes,what county?
❑ t Yes No .
I/We certify under penalty of perjury that the above and foregoing information is true and correct. :-
S) ..ignature of applicant Address of applicant (number and street,ci ;state,and ZIP code)
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Sig r f t zed r sentative Address of authorized representative (number and street,city,state,and ZIP code)
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