Age_Ludwick .,......P9,,,, APPLICATION FOR SENIOR CITIZEN COUNTY 'TOWNSHIP MEM=
PROPERTY TAX BENEFITS
Ntil;;.!'jg State Form 43708(R15/1-20) G;6S0k1 efo I roc.
..._ -_,,,,..--..-- 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.
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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 followi •
January 5 of the calendar year in which the property taxes
Type of benefit requested(Please check all that apply.)
a6ver 65 Deduction from Assessed Valuation EOver 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer)
54-ell O. a Lud -,c
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.
0 No
If name on record is different than that of applicant,indicate below. I Do all joint tenants or tenants in common resilie on the property?
g'res El 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?
Ries El No
Address of contract seller(number and street,city,state,an Z5 ode)
C-J\
Is the property in question:
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[1:1-Rial property 11 Mobile home(/C 6-1-1-7)
Taxing district Key yiumbei-P _L'egal description Record number Page number
A.(0 I2—IFS'102----00 0 I 14 02—T
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
[counting just the homestead site]for the Over 65 Circuit Breaker Credit received before January 1,2020,and$199,999[all Indiana real
Ej..-Yes EJ No 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 age or more on December 31 of the year
,
Have you filed for any other deductions? If Yes,what deductions?
Rs 1E1 No - 1 on."-e Sk-e0•4
Have you filed for deductions in any other county? If Yes,what county?
DYes 2-Nlo
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
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Sign ture of appjlcanrc?
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y,E:j0-diX
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Address of applicant (number and street,city,state,and ZIP code)
?0.2 S Akt, ‘,111 ?C.--knCtf 0 rl _I--.1.1 97(g70
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)
(9-(( c)-3
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PC.-10 312-1702S . --- iictik
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DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer i fig FEMI(I(CCOLIJNIPYAUDITOR