Age_Meier (5) APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
PROPERTY TAX BENEFITS
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:1 State Form 43708(R15/1-20
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% --- Prescribed by the Department of Local Government Finance
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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.
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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.
Name of applicant(owner or contract buyer)
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Is applicant the sole egal or equitla oviner? If No,what is his/her exact share or interest? If owned with Joint tenant or tenant in common,indicate with whom.
es 0 No
If name on record is different than that of applicant,indicate below. I Do all joint tenants or tenants in common reside on the prbperty?
[ iiIrs 111No
Name of contr ct seller Has applicant owned or been buying the property under recorded contract for -
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at least one(1)year before claiming deduction?
0 Yes El No •
Address of cons
ract seller(number and street,city,state,and ZIP code) Is the E;.-gperty in question:
TRE4eal property ['Mobile home(IC 6-1-1-7)
TaWig district Key number/Legal description I Record number Page number
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Does applicant reside on property? Assessed value of the property as of current year assessment date(May not exceed$200,000 for Over 55 Deduction or$199,999
(;rooupnetriiny3jiburstttreecILoemrgtead CircuitstelirefoaTere Over 65 CiirlycuaitpBprdkfeorrCarneedritpreecceemiviejed rbgorlottrfeyelie2v0erlafon
individual's spouse.)See reverse for details. ri,EL $
Have you filed for any other deductio2,? .!Vi'.I what deduc(io ?
I1G,"res 11 No ovy-1 r
Have you filed for deductions in any other county? If Yes,what county?
III Yes 5<No JUN 0 5 202,
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I/We certify under penalty of perjury that the above and foregoing information is true and co429.ac .
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Si naturi applicant /75
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A dress o applicant (number and street,city,state,and ZIP ode)
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Signature of authorized representative J Date(month,day,year)
Address of authorized representative (number and street,city,state,and ZIP code)
Signature of County Auditor ., Date(month,day,year)
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