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Age_Briody ..0 RAr,� APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR 6 ,4%- < PROPERTY TAX BENEFITS J ktA State Form 43705(R15/1-20) 5 ` ', Prescribed by the Department of Local Government Finance C9 (t p��1 I. v� a3 /ats File Mark Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. INSTRUCTIONS: To be fined 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 li that apply.) Over 65 Deduction from Assessed Valuation E Over 65 Circuit Breaker Credit j Name of applicant(owner o ontract buyer) J b qr...$ A( D• ,C'C� z e\OC1 co 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. Ries ❑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? Ei"Yes ❑No Name of contract seller Has applicant owned or been buying the property under recorded contract for et least one(1)year before claiming deduction? nyes ❑No Address of contract seller(number and street,city,state,and ZIP code) Is the property in question: LMeal property ❑Mobile home(IC 6-1-1-7) Taxing district Key number/Legal description Record number Page number 3 d\,.r.50 a c1- 09-l6-4po- ool. g?s ^ oa 4 Does applicant reside on p pe . Assessed value of the property as of current year assessment date(May not exceed$200,000 for Over 65 Deduction or5199,999 Yes [1]No [counting just the homestead site]for the Over 65 Circuit Breaker Credit received before January 1,2020,and$199,999[all Indiana real 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 r more on December 31 of the year Have you filed for deductions in any other county?ty� If Yes,what county? ❑Yes t ,�'Ivo I/We certify under penalty of perjury that the above and foregoing information is true and correct. �r r e.). • 0,_,(j:s) • h l'.I°�?'.III- ii OEM onth,Clio yea, d, 3 Address of applicant umber and street,city,state,and ZIP code) aI L{' E \,.1 o.r-("t'_.r\foil 2d V\Aub51-0.4)- ,N Li 76 3 9 ut a i represen a e' ,- Date(month,day,year) Add,-ss of authorized repre a (number and street,city, tate,and ZIP code) Signature of Cqu ty Auditor onth,day,year)AAJCJL--. FILFjL5em � JUN 2 6 2023 G -)-2i.c/lE3SONlizgUNTYlli-Ael-46:n4)UDITOR