Age_Manning "'r•a APPLICATION FOR SENIOR CITIZEN
{ COUNTY TOWNSHIP
PROPERTY TAX BENEFITS \ - __T_ YEAR
�. " State Form 43708(R 16!1 0 2 Z '1'V�i rk
I111
-'"'•-� Prescribed by the Department of Local GovernmentFnarc<_
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. 1\1 le
INSTRUCTIONS: To be filed in person or by mail with the county auditor of the county where the property is located. ` 4
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 a':that apply) -- --
ver 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Appl-ca_t(o.v,re,-,c ^!rac:b, er'
,"
If Owned with Joint Tenant or Tena^t in Common.Indicate with Whom ,
Yes _ No
'If Name on Record is D fferent than Applicant.Indicate Below. Do All Joint Tenants or Tenants in Common Reside on the Property?
_ Yes _ No
Name of Cart-act Salle• Has Applicant Owned or Bougrt the Property Under Rec ed Contract for at Least i
I One Ill Year before Claiming Deduction? Yes _ No
• Address of Contract Seller(number and street city.state and ZIP code! Is e operty in Question-
Real Property _ Mobile Home(IC 6-1-1-7)
Taxing District 'Key Number;Legal Descriptio^
Record Number �Page Number
-�/�
Does Applicant Reside on Property? Assessed value of the property as of current year assessment date(May not exceed 3240.000 fcr Over 65 Deduction or
S199.999[counting just the homestead sate]for the Over 65 Circuit Breaker Credit received before January 1.2020 and S199,999[al ,
A'es - No Indiana real property]for the
es ❑No #k
Have You Fled fcr D uc on in Any Other County? If Y s.What County? _ ----
' ❑Yes No y
'46 .
IM/e certify under penalty of perjury t at the above and foregoing information is true and corre�'C(9S+ON 02ei)
I Signature of Applicant O� ( nt r
m day. )\
l �� tiTy"Z- 1
r\/,I 4/,
`' Address o ppl;ca umber and street city state.and ZIP code) O
yT0 C-A
3n8 E � ol1e,^ R
Signature of Authored Represe ve 'Date(month day.year)
Address of Authorized Representative r,tuber and street cty.state and ZIP code;
S grat.J'e o'Courty Aud:tur 'D722o2 .
(mch. day year,
mv0 ,_lb- S
DISTRIBUTION: Original-County Auditor, File-Stamped Copy-Taxpayer