HomeMy WebLinkAboutAge_Mason cl' 574"9. APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
4 • • 1. PROPERTY TAX BENEFITS
s. `',i State Form 43708(R19/ 7-25)
• COm 2
'a'• 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 year in
which the property taxes are first due and payable.
See reverse side for additional instructions and qualifications
Type of Benefit Requested (Please c all that apply)
• ver 65 Credit Over 65 Circuit Breaker Credit
Name of Applicant(owner
'or conk bu r) Telephone Number /E it Address
AA A N\ wn
Is • • • • -: t I - • - Legal or Equitable Owner? it No. What is Applicant's Exact Share or Interest? If Owned with Joint Tenant or Tenant in Common, Indicate with Whom
0 Yes ❑No
It Name on •":', • is Different than Applicant, Indicate Below Do All Joint Tenants or Tenants in C eside on the Property?
es ❑No
Name of Contract Seller Has Applicant Owned or Bought the ' ••& Under Recorded Contract
for at Least One(1)Year before Claming,v --• , .
/I Yes ❑ No
Address of Contract Seller (number and street, city, state, and ZIP code) e Property in Question:
Real Property ❑ Mobile Home(IC 6-1.1-7)
Taxing Distract Key Number/Legal Description Record Number Page Number
c9° -4- 2-C — 1 LI -19 -2<p) - 000 . --\.A - 0 0 - -
Did Applicant qualify for the homestead standard deduction in the preceding year(or was applicant marred 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?
is the Applicant 65 Years of Age or More on December 31 of the Year Pnor to the Year Taxes are First Due& Payable? /li\Yes ❑ No
$
I/We certify under penalty of perjury that the above and foregoing information is true and correct_
i
A„.
Signature of Applicant Date (month, day, year)
Address of licant (number s , city, st and ZiP code)
tT3 Ilimil
Signature of Authorized Representative Date (month. day, year) ' ummil°
prill4
Address of Authorized Representative (number and street, city, state, and ZiP code) C
Z
Signature of Courtly A •tor Date (month, day, ye D
'On \sn—S-@)--'
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1� . twill._____
DISTRIBUTION: Original — County Auditor; File-Stamped Copy — Taxpayer