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Age_Kolb r•f.„;4 L/•APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR Ar PROPERTY TAX BENEFITS a' IP State Form 43708(R15/1-20) r �n coop'? Prescribed by the Department of Local Government Finance r n�'v 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. Type of benefit requested(Please check all hat apply.) ver 65 Deduction from Assessed Valuation -&9 r 65 Circuit Breaker Credit Name of applicant(owner or contract buyer) s l;>~ t (4I,l\ Is applicant the sole legal or equitable owner? If No.what is his/her exact share or interest? If owned with joint tenant or tenant in common,indicate with whom. II"`Tes ❑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? Ls ❑No Name of contract seller Has applicant owned or been buying the property under recorded c ntract for at least one(1)year before claiming deduction? pp�� es El No Address of contract seller(number and stree ate,and/'ZIP code) V Is the pro rty in question: 2- —(2-06 -L 0 0 _©0 3 eat property ❑Mobile home(IC 6-1-1-7) Taxing district Key number/Legal description Record number Page number Pc--.. +\C-,e--{-C,A — _ . O S -®dZ-6r_ 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 es ❑No (counting just the homestead site)(or the Over 65 Circuit Breaker Credit received before January 1,2020,and$199,999[all Indiana real property)for the Over Yes ❑No A-C4s, ‘kow eve'S\--eca Have you filed for deductions in any other county? If Yes,what county? ❑Yes ®moo I/We certify under penalty of perjury that the above and foregoing information is true and correct. Signature of applicant Date(month,day,year) cevino. i�o - 8 — / - .Dzz Address of applicant (number and street,cit state,and ZIP code) /p FinG� Ln r�AL fo# %A" 4 7670 Signature of authorized representative Date(month,day,year) Address of authorized representative (number and street,city,state,and ZIP code) Signature of Co u ty Auditor Date(month,day,year) t°`• AUGAUB Wo22 .ta. R �4o7�o�,� DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer