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Age_Ice • 4,E 5-44 APPLICATION FOR SENIOR CITIZEN �/- PROPERTY TAX BENEFITS c�ouNTY TOWNSHIP YEAR t 'I j' State Form 43708(R15/1-20) \.-�('\ 3 1� . A O�G ""�ti= : ��J P&G S ie. "� 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 County Auditor of the county where the property is located. Filing Date: Form must be completed and signed by December 31 and filed with the county auditor or postmarked by the following January 5 of the calendar year in which the property taxes are first due and payable. See reverse side for additional instructions and qualifications. Type of benefit requested(Please he, all that apply.) 1.1 Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit .A Name of applicant(ownor con,4.uyer) ,� .4 TIcktko �.cC l 'fin ice . Is applicant the sol- egal o e. it-. owner? If No,what is his/her exact share or interest? If owned with joint tenant or tenant in common,indicate with whom. /.'1Yes ❑No If name on record is different.an that of applicant,indicate below. Do all joint tenants or tenants in common residue° the property? }�IYes El No Name of contract seller Has applicant owned or been buying the property under re rd contract for at least one(1)year before claiming deduction? es ❑No Address of contract seller(number and street,city,state,and ZIP code) I th property in question: Real property ❑Mobile home(IC 6-1-1-7) Taxing district ©�� Key number/Legal description Record number Page number 26-02 5f--►Z6- Oo 0 .3q- -0\9- Does applicant reside on p op ? 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 $ individual's spouse.)See reverse for details. Have you filed for any other d u ons? If Yes,w at deduction? Yes ❑No 'S Ik Have you filed for deductions in an othe co ? If Yes,what county? ❑Yes No I/We certify under penalty of perjury that the above and foregoing information is true and correct. X Signat fe '!applicant Date(mo th day,y== j 0 e Q___ 0 - AO— C=9 e)0-0 or Address gf applicant (number(� and street ci state,and ZIP code) E . `c , NADA 114 kl 0- in - 0. Signature of authorized representative / Date(month,day,year) Address of authorized representative (number and street,city,state, d ZIP code) I r, Signature of County Audito "9 Cji �c4 $ Date(month, ay, ar 7 '''S lb �4\93\101.(C\ O DISTRIBUTION: Original-County Auditor; File-Stamp Copy-Taxpayer