Age_Wilson (2) APPLICATION FOR SENIOR CITIZEN
PROPERTY TAX BENEFITS _ •CO TOWNSHIP YEAR
r State Form 43708(R16/1.231 `� �R '/n�hI
'm••-" Prescribed by the Department of Local Gc e-'i''-ena F'nance J •
lv��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 flied 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)
65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
i Na, e of Applicant(owner r contraMOver
yer)
If Owned with Joint Tenant or Ter,a-!'n Common.Indicate with Whom
i
Yes `. No
If Name on Record is Different than Applicant,Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property?
--__ APR 0 9 ZOZ - Yes �-1 No
Name of Contract Seller I s Applicant Owned or Bought the Property Lind r R corded Contract for at Least
/2 ,/ e(1)Year before Claiming Deduction? es E No
.Address or Contract Seller(number and street city state COUNTY AUDI Is t e Property in Quest' n
eal Property _ Mobile Home(IC 6-1.1-7)
Taxing District Key Number i Legal Description ll Record Number Page Number
oc I • 2,6 ^22-01- �02-000 . 029' -0Oq .
Does Appl;cant Re ide on Property' Assessed value of the property as of current year assessment date(May not exceed S240.000 for Over 65 Deduction or •
_. 5199.999(counting just the homestead site)for the Over 65 Circuit Breaker Credit received before January 1,2020 and S199.999(a'
Yes — No Indiana real property]for the Over 65 Circuit Breaker Credit initially applied for after December 31, 2019.)See reverse for details.
Is the Applica t 6 Year of Age or More on December 31 of the Year Prior Appi ot's ate ofBirth(month.
Have You Filed for Any Oth r Deductions? Y s What Deductions?
Yes ❑No _ - ,
—
Have You Filed for D uc on in Any Other County? i If Y .What County" _
❑Yes ( (No
I]We certify under penalty of perjury that the above and foregoing information is true and correct.
)(
nah f Applicant Da (mo th da .ye!/
az°
eyj
LI
ddress of Applicant(number and street.a state and ZIP cede' '
Li b t s u es� S f- - "4O-6 9
Signature of Authorized Representative i Date(month day,year)
Address of Authorized Representative(number and street.city.state and ZIP code)
i S gnature of Cour Aur•itor � ate tn. .ay.year)
1-63q---ki)------S
J
DISTRIBUTION: Original-County Auditor: File-Stamped Copy-Taxpayer