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Age_Wade (2)
C9 .,...,(--_ (--- 1 212 1 1 I 'S' „+` .„ ,4 APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR x PROPERTY TAX BENEFITSk ,. State Form 43708 (R19/ 7-25) 2._f Z'C)2) 'fir•:: �0 (II) 'a�• Prescribed by the Department of Local Government Finance 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, signed, and filed with the county auditor or postmarked by January 15 of the calendar year in which the property taxes are first due and payable. See reverse side for additional instructions and qualifications. 1 Type of Benefit Requested (Please checkpf t t apply) i ❑/Over 65 Credit Over 65 Circuit Breaker Credit Name of Applicant (owner or contract buyer) Owned with Joint Tenant or Tenant in Common, Indicate with Whom Yes ❑ No If Name on Record is Different than Applicant, Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property? ❑ Yes ❑ No Name of Contract Seller Has Applicant Owned or Bought the Property Und ecorded Contract for at Least One(1)Year before Claiming Cr . Yes ❑ No Address of Contract Seller (number and street, city, state. and ZiP code) Is the Property in Question eat Property ❑ Mobile Home (IC 6-1.1-7) Taxing District Key Number 1 Legal Description i Record Number Page Number F-- anc-k - 19 - l5 j4 -c)()o - 555 -a,AL9 . Did Applicant qualify for the homestead standard deduction in the preceding year(or was applicant married at the time of death to a deceased spouse who qualified for a homestead standard deduction for the individual's homestead property in the immediately ©Ns ❑ No preceding calendar year) and does Applicant qualify for the homestead standard deduction in the current year? Is the Applicant 65 Years of Age or More on December 31 of the Year Pnor to the Year Taxes are First Due& Payable? es ❑ No $ I/We certify under penalty of perjury that the above and foregoing information is true and correct. Signature o Applicant Date (month, day, year) 7"."---6-4-r•-laS4__Ar- tiJ 1 1-- - 5' - 6 1 . sc Address of Applicant (number and street, city, state, and Z1P code) .. 1 ) a (211 Ft-t) - V/1/) e-- t- 14.4M6-4- j 1-1\P ii-r04-g cp . D ~Signature of Authorized Representative 1 Date (month, day, year) Q 1, j Immm") Address of Authorized Representative (number and street, city, state, and ZIP code) mmillnif W 0 p k Z O h 1 (0 Signature of County Auditor Date (month, day, year) '� m 7(tithl 94_ ii6d- -th 1)._, /2 5-a 5 U DISTRIBUTION: Original - County Auditor; File-Stamped Copy - Taxpayer