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•.` r"'4 APPLICATION FOR SENIOR CITIZEN , COUNTY _ TOWNSHIP _ YEAR
- _PROPERTY TAX BENEFITS v -4-
-02, -- - -i7
State Form 43708 (R19 i 7-25)
•
'ipi• Prescnbed 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. ?\
Type of Benefit Requested (Please the k all that apply)
Ai
Over 65 Credit Over 65 Circuit Breaker Credit _
Name of Applicant (owner or contr ct b er) Telephone Number Em I Address
SCIO\rk \f -Y-e- ( )
fi Is Applicant the S Legal or Equitable Owner? If No, What is Applicant's Exact Share or Interest? If Owned with Joint Tenant or Tenant in Common, Indicate with Whom
Yes ❑ No 1
-
If Name on ord is Different than Applicant. Indicate Below Do All Joint Tenants or Tenants in Corn on Reside on the Property?
es ❑ No
Name of Contract Seller Has Applicant Owned or Bought the P,•pe Under Recorded Contract
for at Least One(1)Year before Claiming Cr it?
Yes _ ElNo
Address of Contract Seller (number and street, city. state, and ZiP code) Is the P operty in Question:
111 Real Property ❑ Mobile Home (IC 6-1.1-7)
Taxing Distnct 1 Key Number/ Legal Description Record Number I Page Number
0 ?_---(9-
-PWs t2c _ Ik -16 ,?.0 o.--o2 oI1 -02'-
Did Applicant qualify for the homesteadstandard deduction in the preceding year (or was applicant married at the time of death to l
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? ---I
annually adjusted.]See reverse for details. $
------ -- ---4-74
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I/We certify under penalty of perjury that the above and foregoing information is true and correct.
.- -:bL-- -- --- - - --- ! Date (month. day. year} -
S�gna re of Applicant • �c_.__ _ . ! _. .s,,, (2-Ar (asz. __ N
1,5 __ .
ddress f Applicant (number
and street. city, state. and
and ZiP code) 2O2C
/"2 J t✓ W J ` ` . G�es' UU
— / Date (montd
Signature of Authorized Representative iti76'
Address of Authorized Representative (number and street, city. state. and ZIP code) 0R
Signatur Coun Auditor Date (month. day. year)
DISTRIBUTION: Onginal - County Auditor: File-Stamped Copy - Taxpayer