HomeMy WebLinkAboutAge_Kiesel .t--,=.,,, APPLICATION FOR SENIOR CITIZEN COUNTY
UNTY TOWNSHIP YEAR
1= PROPERTY TAX BENEFITS
0 i State Form 43708(R15/1-20) S
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ter' Prescribed by the Department of Local Government Finance �O�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
Do ail joint tenants or tenants in common reside on the property?
❑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) \ t e property in question:
Real property ❑Mobile home(IC 6-1-1-7)
Taxing district Key number/Legal description ///��` Record number Page number
0 C` °k 2— l�.— \-3-ac..\—o c 0-s l 8 -0 09
Does applicant reside on pr p ? 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 fall Indiana real
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 ge r more on Decem er 1 of the year
$
Have you filed for any other de u ions? If Yes,w eductions?
aYes ❑No _
Have you filed for deductions i other ty? If Yes,what county?
❑Yes No
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
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Signature of applicant /s/J�1 Date(mont5 )�yea -
A�ess of appli n (number 4d street, ity,state,and Z�de)
2-11 �uK street, t ,,A - .
Signature of authorized representative , Date(month,day,year)
Address of authorized representative (number and street,city,state,and ZIP code)
Signature of C,pt y udit - Date(month pay,
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MA`S 11 2022
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DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer