Age_Baker .�,, .,,, APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
PROPERTY TAX BENEFITS ^�
3� -'- State Form 43708(R15/1-20) / /I so� 0 1 S ao / Z
,__ `.. Prescribed by the Department of Local Government Finance J (((f "`��\ L�
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
Over 65 Deduction from Assessed Valuation ®Over 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer)
Baker, Shirley
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.
Dyes ❑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?
❑Yes ONo
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 the property in question:
®Real property ❑Mobile home(/C 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
018 26-04-11-100-002.437-018
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
❑Yes ❑No (counting just the homestead ste)for the Over 65 Circuit Breaker Credit received before January 1,2020,and$199,999(all Indiana real
property)for the Over
$
individual's spouse.)See reverse for details. •_)!/
Have you filed for any other deductions? If Yes,what deductions? O rl T 1 {+ 21322. /
0Yes ❑No Hstead l L�IIV///
Have you filed for deductions in any other county? If Yes,what county? /J L
❑Yes [2]No s/„ C.ri
z,./ . i�'e"r"')
SON COUNTY AUDITOR
l/We certify under penalty of perjury that the above and foregoing information is true and cow.
X Sign reof applica I Date(month,day,year)
-''YL2i a_ J �- L_
F- `_'UX IAddress of applicant (nury-er and street,city,state,and ZIP code)
5841 N 185 W,tPatoka < IN 47666
Signature of authorized representative Date(month,day,year)
Address of authorized representative (number and street,city,state,and ZIP code)
Signature of County Auditor Date(month,day,year)
/`1Zik-,3 1 o-. � ��_.— ( /I3/a te
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer