Age_Parker -- APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
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try\a PROPERTY TAX BENEFITS
iw,191A. State Form 43708(R15/1-20)
-�° 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. ILE
11) .
INSTRUCTIONS: To be filed in person or by mail with the County Auditor of the county where the property is located.
FilingDate: Form must be completed and signed byDecember 31 and filed with the �1 A.n. '
p 9 county auditor or postmarked by tl yy�n�
January 5 of the calendar year in which the property taxes are first due and payable. .11 2020
See reverse side for additional instructions and qualifications. Gfe
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Type of benefit requested(Please check all that apply) .y
®Over 65 Deduction from Assessed Valuation ®Over 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer) �R
Donna M. Parker
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?
— — -- _-— 0Yes -
Name of contract seller Has applicant owned or been buying the property under recorded contract for
N/A at least one(1)year before claiming deduction?
0Yes No
Address of contract seller(number and street,city,state,and ZIP code) Is the property in question:
N/A 17.1Real property ❑Mobile home(IC 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
Ft. Branch 26-19-18-303-000.587-026
Does applicant reside on property? Assessed value of the property as of current year assessment date(May not exceed$200,000 for Over 65 Deduction or$199,999
®Yes ❑No [counting just the homestead site]for the Over 65 Circuit Breaker Credit received before January 1,2020,and$199,999[all Indiana real
property]for the Over 65 Circuit Breaker Credit initially applied for after December 31,2019.)See reverse for details.
Is the applicant 65 years of age or more on December 31 of the year
individual's spouse.)See reverse for details.
Have you filed for any other deductions? If Yes,what deductions?
0Yes ❑No Homestead
Have you filed for deductions in any other county? If Yes,what county?
❑Yes 0 No
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
t-cacao a of epp!icart J H Date(monthT day,year
Address of applicant (number and street,city,state,and ZIP code)
106 N. Walter St., Ft. Branch, IN 47648
Signature of authorized representative Date(month,day,year)
Address of authorized representative (number and street,city,state,and ZIP code)
Sign ure of County Auditor Date(month,day,year)
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RECEIVED
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer
APR 17 2020
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