Age_Bassett ,�bnre APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
PROPERTY TAX BENEFITS" 1
\E�' ' l/l,= State Form 43708(R15/1-20) Ton°e. " Prescribed by the Department of Local Government Finance 2,3-___ ' v v 1 .
File Mark
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9.
i
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(owne contract buyer)
Bassett, Ter / Marlene M •
Is applicant the sole le r. If No,what is his/her exact share or in 'L ed with joint tenant or tenant in common,indicate with whom.
®Yes ❑No ('
If name on record is different than that of applicant,indicate below. J� Do all joint tenants or tenants in common reside onproperty?
pp t m n r id the pr p rty.
�yQ1111 ®Yes ❑No
Name of contract seller 1 AN IF4aPapplicant 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) /] ill( . ',he property in question:
k Ili.444,1 U�Y A0O1� �I Real property ❑Mobile home(IC 6-1-1-7)
Taxing districtek)/........ Key number/Legal description ' 18SOt CO Record number Page number
26-12-27-200-000.09�027
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
$
individual's spouse.)See reverse for details.
Have you filed for any other deductions? If Yes,what deductions?
IZI Yes ❑No H'stead, Vet
Have you filed for deductions in any other county? If Yes,what county?
❑Yes ®No
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of applicant Date(month,day,year)
1/28/2021
Address o applicant (number and street,city,state,and ZIP code)
3253 S 250 S, 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 oMidi or Date(month,day,year)
`` V4111) 1/21/2021
V kVA •
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DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer