HomeMy WebLinkAboutAge_Beard . ' APPLICATION FOR SENIOR CITIZEN
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411.
l,r.�: �'�I COUNTY TOWNSHIP YEAR
PROPERTY TAX BENEFITS
State Form 43708(R19 I 7-25)•Itle 21 r.� () '9- 20Z'� "..• 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 4- v K rr' �
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Type of Benefit Requested (Please the all that apply)
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Over 65 Credit Over 65 Circuit Breaker Credit
Name of Cant(owner or contr r
if Owned with Joint Tenant or Tenant in Common, Indicate with Whom
Yes El No
If Name on ec is Different than Applicant. Indicate Below Do All Joint Tenants or Tenants in C mon Reside on the Property?
Yes ❑No
Name of Contract Seller Has Applicant Owned or Bought the Under Recorded Contract
for at Least One(1)Year before • • , • :, .
I: 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 Key Number/Legal De_wiption / Record Number Page Number
2‘- O6- 06-3°0 --'0oo - (-, - 01�- .
Did Applicant qualify for the homestead standard deduction in the preceding year(or was applicant marned at the time of death to
a deceased spouse who qualified for a homestead standard deduction for the individual's homestead properly 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 Prior to the Year Taxes are Fast Due a Payable? Yes El No
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of Applicant,,je-1)(1-43 \V 1-dt-eiL- 1 Date (month, clay, year)
Poi ..pie-
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Address of Applicant (number and street, c ty, state, and ZIP code) -6_,()
____
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of Authorized Re
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presentative l Date (moot year) <2,0�
ss 6
Address of Authorized Representative (number and street, city, state, and ZIP code) �C,_C2
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Signature o1 County Auditor Date (moat , day, ye ) ��'\-\r , (4.1..-tir) ,_ ) • 2__ 2,Ak ),() Q
DISTRIBUTION: Onginal - County Auditor; File-Stamped Copy - Taxpayer