Age_Heldt-Crawford <+`"''-!'c.. APPLICATION FOR SENIOR CITIZEN ---
} COUNTY TOWNSHIP YEAR
E PROPERTY TAX BENEFITS
,/ Stale Form 43708(R' _- {{ l J v� 2 2�
IPr scrnbeo by the Department ofGovernmentLocal Fna.ce -
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 a'!that apply)
Over 65 Deduction from Assessed Valuation
Over 65 Circuit Breaker Credit
me o`Applicant(owner Cr contract uyer;
? If Owned with Joint Tenant or Tenant in Common.Indicate with Whom
_ Yes _ No
If Name on Record is afferent than Applicant,Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property?
•
_
— Yes -1 No
Name of Contract Selle i Has Applicant Owned or Bought the Property Under Recorded Contact for at Least
AI I One 0)Year before Claiming Deduction? _ Yes _ No
ddress o'Contract Seller rnumber and street city. state and ZIP code' I Is th P operty in Question —
1 eal Property _ Mobile Home(IC 6r1.1-7)
Taxing D strict Key Number;Legal Descry _ Record Number Page Number
2 -- 26-12- h---too _ Ooe A63 - b23- .
Does Appfcant Reside on Property? Assessed value of the property as of current year assessment date(May not exceed 5240.000 fcr Over 65 Deduction or
5199,999[counting just the homestead site]for the Over 65 Circuit Breaker Credit received
Have Ycu Filed for Any Oth Deductions? ;If Yes,W at Deductions?
El_ _ __ Yes No S .
Have YCJ Fled for D uct n in Any Other County? If Yes.'v hat County? — — -- 41 — — --
❑Yes ❑No
I ify under penal of perjury that the above and foregoing information is true and correct. *,4k
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11770
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Address Applcant(m odel, . ran nee.city state and cOG2
tiTy.e. ,
Signature of Authorized Representative Date lmonM day''
Address of Authorized Representative(number and street.c'ty state and ZIP code- —
i
(.7: „, .
Sgna-ureor o;nt udi, — Date
DISTRIBUTION: Original-County Auditor, File-Stamped Copy-Taxpayer