Age_Davis .M -- APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
l`' `%''y PROPERTY TAX BENEFITS -—
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.q .�; State Form 43708(R15/1-20)
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a"'''< 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.
®Over 65 Deduction from Assessed Valuation ®Over 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer)
Michael Davis
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?
IZIYes ❑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?
ZYeS ❑No
Address of contract seller(number and street,city,state,and ZIP code) Is the property in question:
®Real property ❑Mobile home(IC 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
26-18-13-200-000.040-025
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
(counting just the homestead site]for the Over 65 Circuit Breaker Credit received before January 1,2020,and$199,999(all Indiana real
®YeS ❑NO
property]for the Over 65
!
Have you filed for any other deductions? If Yes,what deductions?
(Yes ❑No Homestead/Mortgage NOV you filed for deductions in any other county? If Yes,what county? 2020
❑Yes [ZNo
I/We certify under penalty of perjury that the above and foregoing information is true an is Di.4.L
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Sigureofapplicant
rI�SOR! OOL�TI Ddt� otilfli? ay,year)
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,� � ���„" 11/09/2020
Address of applicant (number and street,city,state,and ZIP code)
637 W 650 S, Ft Branch , IN 47648
Signature of authorized representative Date(month,day,year)
Address of authorized representative (number and street,city,state,and ZIP code)
Signature of County Audi 'n- ctirC_____ Date(month,day,year) /09/2020
lCICS)
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer