Age_Bachman APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
4 I. PROPERTY TAX BENEFITS
State Form 43708(R15/1-20)
Prescribed by the Department of Local Government Finance 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 payable.
See reverse side for additional instructions and qualifications.
Type of benefit requested(Please check all that apply.)
Over 65 Deduction from Assessed Valuation Er6ver 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer)
Alene Bachman Cindi Paulin (Daughter) Phone#678-468-7939
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.
VI Yes LIN° •
If name on record is different than that of applicant,indicate below. Do.all joint tenants or tenants in common.reside on.the-propP.rti? -
ID Yes EiNo
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 El No
Address of contract seller(number and street,city,state,and ZIP code) Is the property in question:
VI Real property LI Mobile home(/C 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
Ft. Branch 26-18-24-202-701.370-026
Does applicant reside on property?
$
individual's spouse.)See reverse for details.
Have you filed for any other deductions? If Yes,what deductio
W6 Yes ON° Homestead
Have you filed for deductions in any other county? If Yes,what county
['Yes INo
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
- Dat7
.2e0,14.ake4,1SL r7 I Q
Address of applicant (number and street,cit,state,and ZIP code)
105 W Oak Street
Signature of authorized representative Date(month,day,year)
Address of authorized representative (number and street,city,state,and ZIP code)
Signature of County Auditor ... t-) Date Cr Qionr,day,year)
Vrr CIIND Q), rry - 01
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DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer
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