HomeMy WebLinkAboutAge_Ghanta
-- . ,•,' "„ „k APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP • YEAR
A.' z PROPERTY TAX BENEFITS a,� ieN
� t
. ,,f State Form 43708(R 19 7-25) I 5'0
,a,.
Prescribed by the Department of Local Government Finance AI--
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
)_ ._.
Type of Benefit Requested (Please che5k all that apply)
..et'Over 65 Credit Over 65 Circuit Breaker Credit
Name of Applicant (owner or contract buyer)
r; Yes ❑ No
If Name on 'ecord is Different than Applicant. Indicate Below Do All Joint Tenants or Tenants in Commo 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 Claiming Credit?
.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 gr ftt,, Key Number I Legal Description Record Number Page Number
O.C / AI( C f\ - / Ci°- / 41.
--c2 O 0—CO/ /?1 O- 6tA
Did Applicant qualify for the homestead standard deduction in the preceding year (or was applicant married at the time of death to
Isl
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?
Is the Applicant 65 Years of Age or More on December 31 of the Year Prior to the Year Taxes are First Due& Payable? g Yes ❑ No
Signature of Applicant ��/� r� Date (month. day, year)
. jr.:(vt J(l -
../,/ - -(i--tb
Address of Applicant (number and street. city, state, and ZIP code)
'-2.—q- c\ • L_ - 1 6 QS --(--,RI 139.A t .t.1-/ 1 f\i IH-16 qq- i4N ,
Signature of Authorized Representative Date (month. day, ye r) r 3
I
Address of Authorized Representative (number and street, city. state. and ZIP code) ` 0/yt' ,i' eCkIA77-1-*1-'4,c,,.
_
Sig7luir of Co ty Auditor ittkuLdDate (month, ay, yea) ���71/ littat-OL E ''( j
(1
I . 61/ I 2- 0 (?01 - ,
DISTRIBUTION: Original - County Auditor, File-Stamped Copy - Taxpayer 7