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;.�'R.„'A APPLICATION FOR SENIOR CI
TALED COUNTY TOWNSHIP YEAR
` \ PROPERTY TAX BENEFITS
t`•'� State Form 43708 (R19 / 7-25) 4 6-1) 1)t i t 6LAlc- e Z6
'•,• Prescnbed by the Department of Local Government Finance 2 2fl'6 �14 1 I 1�1 1
Information contained in this document is CONFIDENTIAL pursuant IM6 1.1-35-9.
Instructions: To be filed in person or by mail with the county auditor of the county wh t e party is located.
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Filing Date. Form must be completed, signed, and filed with i r p c5 t t� ed by January 15 of the calendar year in
which the property taxes are first due and payabl SOt4 C
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See reverse side for additional instructions and qualifications.
0.Yes ❑ No
If Name on Record is Different than Applicant, Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property?
1ZI.Yes ❑ No
Name of Contract Seller Has Applicant Owned or Bought the Property Under Recorded Contract
for at Least One(1)Year before Claiming Credit?
El Yes ❑ No
Address of Contract Seller (number and street, city, state, and ZIP code) Is the Property in Question:
Real Property ❑ Mobile Home (IC 6-1.1-7)
Taxing District j 6S`At- 7- Key Number /Legal Description Record Number Page Number
C.:1/4Q Li N.J0 41--KS Sr , 4.: - l Y- 362-.40.-4041 "(_):, , -69 ! --ti--
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 0 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? Yes ❑ No
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I/We certify under penalty of perjury that the above and foregoing information true an correct.
_ �j 7
Signatur of Applicant (7744/4.4-;°
/ Date (month, day, year)
/ - //2 -- 2dZ ,C
i r4 411.1"1 a SirhYr► �1�Address of Applicant numbers d street, city state, and Z! ode) ]
/ 1 i (14-11,61(4--k-fOuz .A6- ' I Iu 1LY 3 '
Signature of Authorized Representative t I Date (month, day, year)
Address of Authorized Representative (number and street, city, state, and ZIP code)
6
Y t
Sign t reof County Audit \OPC.U.t.y) 044.1 Date (month day. year)
DISTRIBUTION: Original - County Auditor: File-Stamped Copy - Taxpayer