Age_Woods ,.. 64- APPLICATION FOR SENIOR CITIZEN
\� C,OUNTY TOWNSHIP YEAR
:;*:,• ,. PROPERTY TAX BENEFITS
�' a;; State Form 43708(R15/1-20) t
J (5-1 �2�
�; it r 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 tiled with the county auditor or postmarked by the following
January 5 of the calendar year in which the property taxes are first due
Type of benefit requested(Please the all that apply.)
Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of applicant(.wn or cop a t buyer) A
LOo0
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.
❑Yes ❑No
If name on record is different that that of applicant,indicate below. Do all j5int tenants or tenants in common reside on the property?
❑Yes El No
Name of contract seller Has applicant owned or been buying the property under recorded contract for
al least one(1)year before claiming deduction? ❑Yes ❑No
Address of contract seller(number and street,city,state,and ZIP code) Is t property in question:
Real property ❑Mobile home(IC 6-1-1-7)
Taxing district 6 d d Key number/Legal description Record number Page number
A6-14-06^2•130—001 ‘o29:1 —on C.
Does applicant reside on pro rty? 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]farip e Over 65 Circuit Breaker Credit received before January 1,2020,and$199,999[all Indiana real
property)for the Over 65 Circu t Brear Credit initially applied for after December 31,20i9.)See reverse for details.
Is the applicant 65 years ag or more on Dece ber 1 of the year
Have you filed for any other de coons? If Y hat J dedt re?� 1 S __ 2--__Yes ❑No 11"I��
Have you filed for deductions n an ther c u y? If Yes, hat county?
['Yes o
I/We certify under penalty of perjury the he above and foregoing information is t orrect.
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Signal f applint Date(month,day,year)
d s o applican (number and street,pity state,and ode) 40,p � j
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Signature of authorized represent;hive C'7-60 2' e0? Date( ont „day,y � J .
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Address of authorized representative (number and street,city,state,and ZIP code) /Vpy t
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Signature of County/10li+ Date(month,day,year)
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A c - CT 41/10 /1.02_3
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer