HomeMy WebLinkAboutAge_Wade ,ki„`n . APPLICATION FOR SENIOR CITIZEN<d��, v.� COUNTY TOWNSHIP YEAR
PROPERTY TAX BENEFITS
i'sitrat•• y State Form 43708(R16/1-23) t Co L_b,o- �3
\`-f.,-.. ' Prescribed by the Department of Local Government Finance s r1 h �v
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)
er 65 Deduction from Assessed Valuation LL"1".7ver 65 Circuit Breaker Credit
Name of Applicant(owner or contract buyer) Telephone Number Email Address
Lcrr1 1-?e9011c. V-) 6.`g1e- 43161 ) Sz - 1 SC, 8
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
Lames E No
If Name on Record is Different than Applicant,Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property?
s ❑ No
Name of Contract Seller s A icant Owned or Bought the Property Under Recorded Contract for at Least
One(1)Year before Claiming Deduction?
I -dies ❑ No
Address of Contract Seller(number and street,city.state.and ZIP code) DEC 04 2023 Is the Property in Question:
t eal Property ❑ Mobile Home(IC 6-1.1-7)
Taxing District Key Number/Legal Descrip'or ,
$199,999(counting just the homestead site]for the Over 65 Circuit Breaker Credit received before January 1,2020,and$199,999[al
_
iir<S 11 No Indiana real property]for the
Have You Filed for Any Other Deductions? If Yes,What Deductions?
es ElNo (`b i. a si-e.-1I IJ z s \p`k .>-n
Have You Filed for Deduction in Any Other County? If Yes,What County?
❑Yes No
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signs of Applicant Date(month,day,year)
Sa._ege___ I p f -.2 c 3
A ess of Applica (numbe and street,city.state,and ZIP code)
.2 SS$ 9 oe 00.g. ef Ci T.^l LI 7 6 °
Sig -of Authorized R resentative Date(month,day.year)
Ai
• < G� t Z- o_ !- 0G23
A:dr sof Aurized Representative(number and reef cif state.and d es o p y, ��
Signature of Coun y A or 212 2 Date(month,day,year)
IM11�,ykk Id - y-a
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer