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„..,- t-A' APPLICATION FOR SENIOR CITIZEN;i �' COUNTY TOWNSHIP YEAR
`�' PROPERTY TAX BENEFITS
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i\Piligifr, �+ State Form 43708(R19i725) SV)
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• '•.' - 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 y r i E.)
which the property taxes are first due and payable.
Dc( (4.2:6
See reverse side for additional instructions and qualifications. O
Type of Benefit Requested (Please ck all that apply) �
Over 65 Credit ver 65 Ci/�- g�Credit 7e7
Name of Applicant (owner or contr cf yer)
Owned with Joint Tenant or Ten lar r n, Indicate with Whom
Yes ❑ No O�
If Name on ec rd 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 Under Recorded Contract
for at Least One(1)Year before Claimin C dit?
Yes ❑ No
Address of Contract Seller (number and street, city, state, and ZIP code) Is th roperty in Question.
eal Property ❑ Mobile Home (IC 6-1.1-7)
Taxing District Key Number I Legal Description Record Number Page Number
02 r . 26 - i ) -31 ^1-ta --o04 2_9- 021 .
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 Yes ❑ No
preceding calendar year) and does Applicant qualify for the homestead standard deduction in the current year?
$
ITWe certify under penalty of perjury that the above and foregoing information is true and correct.
Signat re of Applicant Date (month, ay, ear
(7:1--vtriA-04-4••••-u.
ij 644.11.../d„.....„),1,..wi .
11.-- 9 z 5---- - ,
Address ofjcant (number and street, city, state, and ZiP code)
112 2_ S C 00 0) "Nr,\\f —ter)- b
Signature of Authonzed Representative Date (month, day, year)
Address of Authorized Representative (number and street, city, state, and ZiP code)
Signature of County Auditor Date (mon___4_,,
th. day. ear)
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DISTRIBUTION: Original - County Auditor: File-Stamped Copy - Taxpayer