Age_Julian .M6*TA*, APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
.,,'-N_ � PROPERTY TAX BENEFITS 1
(t i;
. State Form 43708(R15/1-20) (poi Q �-y A071
+� ,e 6 4/ Prescribed by the Department of Local Government Finance9— ,
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
.
Type of benefit requested(Please check all that apply)
®Over 65 Deduction from Assessed Valuation ®Over 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer)
Julian, Rebecca J
Is applicant the sole legal or eq ' ble owner? If No,what is his/her exact share or interest? If owned with joint tenant or tenant in common,indicate with whom.
es ❑No _
If name on record is d' ent than that of applicant,indicate below. ---Et 1 LE 'II. Do all joint tenants or tenants in common reside on the property?
ZI Yes III No
Name of contract seller Has applicant owned or been buying the property under recorded contract for
y at least one(1)year before claiming deduction? ❑NO
Address of contract seller(number and street,city,state,and ZIP code) DEC Y ® L020 Is the property in question: Yes
®Real property ❑Mobile home(IC 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
027 26-12-16-200-8193' - INITY AIJnITOR
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 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 Applicant's date of birth(month,day,year) If filed by a surviving,unmarried spouse,what was
prior to the year taxes are first due and payable? the spouse's age at the time of death?
®Yes ❑No
Adjusted Gross Income(AGI)of applicant,applicant and spouse,or applicant
$
individual's spouse.)See reverse for details.
Have you filed for any other deductions? If Yes,what deductions?
0Yes III No H'stead/Mortgage/Disability
Have you filed for deductions in any other county? If Yes,what county?
III Yes III No
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Si ure of applicant Date(month,day,year)
/ > c J• T r`z)ry �`/�y l7- �t r �� emir?/ 12/10/2020
Address of applicant (number and street,city,state,and ZI code)
2401 E Top Hat Rd, P'ton, IN 47670
Signature of authorized representative Date(month,day,year)
Address of authorized representative (number and street,city,state,and ZIP code)
•
•
Signature of udito �o Date(month,4 r� ,„2/07_,0
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer