Age_Wills . ^�+4, APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
�4LLII PROPERTY TAX BENEFITS
I.
fr State Form 43708(R15/1-20) //_+ ��
o e;:-' Prescribed by the Department of Local Government Finance V I�son 1 t����'t
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
Type of benefit requested(Please check al that apply)
4-over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer)
G0.110 A W k1\S
Is applicant the sole gal or equitable owner? If No,what is his/her ct are or interest? If owned with joint tenant or tenant in common,indicate with whom
s ❑No LED
If name on record is different than that of applicant,indicate below. Do all joint tenants or tenants in common reside on the property?
s ❑No
Name of contract seller DEC 7 2022 Has applicant owned or been buying the property under recorded contract for
at least one(1)year before claiming deduction?
11't'es ❑No
Address of contract seller(number and street,city,state,and ZIP code) Is the property in question:
Vrhec./'z1 J y,, ) I meal property El Mobile home(IC 6-1-1-7)
Taxing district [�v, `_1 Key number/L®RBt3@4tWtl40UNTY AUDITORPage number
e rt e(�e-`o 1� O' Record number Pa
� ao�� do3 ►��- 8
Does applicant reside on property?op��ty� Assessed value of the property as of current year assessment date(May not exceed$200,000 for Over 65 Deduction or$199,999
Lyres ❑No [counting just the homestead
/
S ❑No F(O"N/�.e-S T LCLa1 ( I (5 c=•‘e•%A.
Have you filed for deductions in any other county? If Yes,what county? �� �-
❑Yes rii..1<—
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of appli t t tt t Date(month,day,year)
Address of applicant (number nd street,city,state,and ZIP code)
l OO c 3 ( e.. 4a S I- P(=1 nc a.fo J e/76 'c
Signature of authorized representative
Date(month,day,year)
Address of authorized representative (number and street,city,state,and ZIP code)
Signature of County Auditor
Q A_ �� Date(month,day,year)
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer