Age_Robling (2) s,,.•.=*+r. APPLICATION FOR SENIOR CITIZEN COUNTY
UNTY TOWNSHIP YEAR
*kilt
PROPERTY TAX BENEFITS
i State Form 43708(R15/1-20) O i ]� Cam/ `Q
' :/ Prescribed by the Department of Local Government Finance "�SQ'� v
es
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 n r r contr ct uyer)
Alto\ �cnq
Is applicant the sole legal or egitltible 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?
El 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 tl- property in question:
Real property El Mobile home(IC 6-1-1-7)
Taxing district Key number/Legal description ///��` Record number Page number
US aV-04-1z-400-o0I - 6- 018 .
Does applicant reside on op rty? 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 o a or more on December 31 of the year
$
individual's spouse.)See reverse for details.
Have you filed for any other de u ions? If Ye hat deductiprty�
Yes ❑No ' c\� , '
Have you filed for deductions i a\'iy other ```'''nty? If Yes,what county?
CI Yes �JNo
I/We certify under penalty of perju that the above and foregoing information is true and correct.
X Si tur app}� Date(month,day,year)
1 L\• 22-- 2_2_
nd ZIP code
A dress o applicant (n ber a e�c sta e, )
. 3 6�-p N 1 1 / t +on -DO --1-16110.
Signature of authorized represents. / Date(month,day,year)
-2Z- 22
Address of authorized representative (number and street,city,state,and ZIP code)
Signature of County Au i or Date(month,day,year)
CYKD
-_
FILED
APR 2 2 Zfl.
O
/ _4 f
GIgSON
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer