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el;)",. . APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
7 PROPERTY TAX BENEFITS 1
t `
State Form 43708(R13/4 15) GG
se ' 1 F+ I ei,,�,2 b'2e Prescribed by the Department of Local Government Finance
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 ho 1. assessed as real property:During the twelve(12)months .
before March 31 of the year the deduction is to be effective. ilig
See reverse side for additional instructions and qualifications. ` C 2 2 2J CZ _ •• Type of benefit reque ed( ease check all that apply) �
Over 65 Deduction from Assessed Valuation ❑ Over 65 Circuit Breaker Credit
Name of applicant owner r contract buyer)•
J ,ea1
Is applicant the sole legal or equitable owner? If No,what is s/h r exact share or interest? If owned with joint tenant or tenant in common,
indicate with whom
Yes ❑ No
If name on record is di even han that of applicant,indicate below I.L Do all joint tenants or tenants in common reside on the property?
Yes ❑ No
Name of contract seller Has applicant owned or been buying t e property under recorded
FEB 2 7 2020 contract for at least one(1)year be re laiming deduction?
Yes ❑ No
Address of contract seller(number and street,city,state,and ZIP code) .��` �' Is the property in question:
gip F3ty v6UN7'Y�(�D Real property E Mobile home(IC 6-1-1-7)
Taxing district Key number/Legal description AUDITOR Re ord number Page number
26— 19.1Ct— l 0 l —000 .LASC o26
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 De mbe 1 of the year
Have you filed for any other deductions? If Yes,what deductions? ,
Yes ❑ No 1 1 S J %
Have you filed for deductions in any other county? If Yes,what county?
❑ Yes �i No
I/We certify under penalty of perjury that the above a • foregoing information is true and correct.
Signature applicant C Address of applicant (number and street,city'state,and ZIP code) WRYGvicii
• re of authorized represents Address of authorized representative (number and street,cr�state,and ZIP code)