Age_Dunning •
E R,=ems APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
PROPERTY TAX BENEFITS
` " State Form 43708(R15/1-20)
Prescribed by the Department of Local Government Finance
JUN File Mark
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. JUN 2 2020
INSTRUCTIONS: To be filed in person or by mail with the County Auditor of the county where the property is located. 4
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Filing Date: Form must be completed and signed by December 31 and filed with the county auditor or postm (: •
January 5 of the calendar year in which the property taxes are first due and payable. OUNTy AV•
O(r
OR
See reverse side for additional instructions and qualifications.
Type of benefit requested(Please the all that apply)
ver 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name ��(owne c ntrect y r) �L��/!Z1 r '/
/A` /AG�r�
Is applicant the sole legal or e itable owner? If No,what i i er exact share or interest? If owned with joint tenant or tenant in common,indicate with whom.
Yes ❑No
If name on record is differ nt than that of applicant,indicate below. Do all joint tenants or tenants in common reside on the property?
❑Yes No
Name of contract seller Has applicant owned or been buying the property under recorded contract for
at least one(1)year before claiming deduction?
❑Yes No
Address of contract seller(number and street,city,state,and ZIP code) Is the roperty in question:
Real property ❑Mobile home(/C 6-1-1-7)
ax' g ist' t K number/Legal description Record number Page number
'42-65 Oo-p OO i77-GbZ 7
Does applicant reside on pr erty? 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
❑Yes No
Have you filed for deductions in any other county? If Yes,what county?
El Yes ❑No
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signat e of applicant Date(month,day,year)
dress of applicant (number and street,c'ty,state, nd Zj'co e)
C/Q applicant
(/e \ ' _
Signature of authorized representative Date(month,day,year)
Address of authorized representative (number and street,city,state,and ZIP code)
Signature of County Auditor Date(month,day,year)
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer