HomeMy WebLinkAboutAge_Hargis �t_�•=.4 APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
a �. PROPERTY TAX BENEFITS
- State Form 43708(R15/1-20) G 16 Son ANOI'� oMelr`�
,e,,� 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
Has applicant owned or been buying the property under recorded contract for
at least one(1)year before claiming deduction?
Ell'es ❑No
Address of contract seller(number and street,city,state,and ZIP code) Is the property in question:
ErfReal property ❑Mobile home(/C 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
/}1 bi44-40naer e26-(1-oq- v?o0- coo. $c)l- Cb1-1
Does applicant reside-dn property? 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[all Indiana real
property]for the Over
$
Have you filed for any other deductions? If Yes,what deductions?
L s ❑No it0-04-e
Have you filed for deductions in any other c,�oou,n��ty? If Yes,what county?
❑Yes L 11
I/We certify under penalty of perjury th t the above and foregoing information is true and correct.
i
Signature of applicant f Date(month,day,year)
L... ---/7/ cl-'. -----
Address of applicant (number and street, ity,state,and ZIP code)
6--1/ 5 5R6S 0 v./04st,,ILe TN q 7 6 6 5-
Signature of authorized representative Date(month,day,year)
Address of authorized representative (number and street,city,state,and ZIP code)
Signature of County Au itor IINlAI�' / Date(month,day. r)
/c c,
FILED
MAY 9 202Z
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer GIB Y AUDITOR
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