Age_Beasley �,`'"- APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
41 PROPERTY TAX BENEFITS
�\ State Form 43708(R16/1-23) 1`p'j0 V1 CO I V ye 1e o 93
_ir 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 and signed by December 31 and filed with the county auditor or postmarked by the following
January 5 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 check all that apply) �✓
IJ Uver 65 Deduction from
Owned with Joint Tenant or Tenant in Common,Indicate with Whom
Ls ❑ No
If Name on Record is Different than Applicant,Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property?
gas ❑ No
Name of Contract Seller Has Applicant Owned or Bought the Property Under Recorded Contract for at Least
One(1)Year before Claiming Deduction? ❑'f'es ❑ No
Address of Contract Seller(number and street,city,state,and ZIP code) Is the Property in Question:
LR Real Property ❑ Mobile Home(IC 6-1.1-7)
Taxing District Key Number/Legal Description Record Number Page Number
CO uin1bta 36- i3-ck-3 --ooI. 3coo— oG
Does Applicant Reside on Property? Assessed value of the property as of current year assessment date(May not exceed$240,000 for Over 65 Deduction or
$199,999(counting just the homestead site]for the Over 65 Circuit Breaker Credit received before January 1,2020,and$199,999(al
❑ Yes ❑ No Indiana real property]for
Have You Filed for Any Other Deductions? If Yes,What Deductions? �D
pyres ❑No l��e S� /
-a-- --)./ IP
Have You Filed for Deduction in Any Other County? If Yes,What County? ---
El Yes C3 N AU G 3 0 2023
I/We certify under penalty of perjury that the above and foregoing informati is true and correct. (� l 't
Signatu plicant 1 / Da ( one j ( a part ;n4)
,mf 8 _4444-Z-v- \/ COUNTY AUDITOR
Ad ss ofApplicanC(number and street,city,state,and ZIP code)03a S �'
Signature o�County Audito N,Date(month,day,year)
V s d/30/�3 rV
\--(3 - %.........?
DISTRIBUTION: Original—County Auditor; File-Starr ed opy Tax.:yer
�
APPLICATION FOR SENIOR CITIZEN couNTr TOWNSNIP ve.ea
� � PROPERTY TAX BENEFITS
Slale Gpm �3)091R10112-0B) �
'� PrvampeU by Na Depaztn�ent d loW Govarrvrcm Finarca
Mforma;ion wntaincd in tlJS Cpwm¢nt is CONFIOENTIAL wrswm lo IC 61 142� File ark
9 anC IL 61 bJS9
INSTftVLTIONS:
To 6e filed in perton n py maJ wa;� I1�e CountyAUO�;w oll�e counry wherellie prppeRy is bca(eO.
Fdvg Oates: i) Rae/ Properry: Dun�g Ne MeMe (12) monms belae DecemDer 31 0l Ne year Ne OeEUCtion is ro Ga eHactive.
7J MoDYa Hwnes assessed urMer IC 6]. id w mawlacNrad homas nof assessee as real poperty: Dunng Ne tweHe /11)
Delae Marrh 31 0( Ne year Ine tloEUCtbn is (o Je e0ac(ive.
See T�+erse sidB Iw aOOdional insLVCfimS dn0 pua/x5catqn3.
DEC 3 0 2010
� Over 65 Deduclion Irom Assessed Valuation � Over 65 Ciraiil Breaker CreEit
ivre m acP�a (mma. a ronaxt tvyw)
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� ayJicanllM sda bqal a p Wde o+�ne(? 11 No. �Mal n MLMr eaad wr n vueres�> 11 owneE xW ypmeane oNei rtan ywsa.
vH�ra�� MN xnom
� Ves ❑ No
wme m re�a i:
Mw Oeen Ouyvq m CpVidC1 a11eaY me j1) yGd/f
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[tY riwiCtt / IeGN oezmC�
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r n7 V(l � �
mv�srresnerce. �/ Ib
g,� Yes ❑ No
H�u<�mesr.�a�.w�,�«a�o«.mw,a�am.ru
Source of Income qmo�nt of Income
S
S
TOTAL S�� O � 0.00
.+„�oeauction:?
� rw:.m w. aewcw�s n+m a+e. cw�:r' u�. w»t mnav�
❑ �5 y.y No
� WJe ceN/y untler penalry ol perjury that Ne above and foregoing information is true and correcl an0 that the applicant was a resident
of Indiana and owner of Ne aforementioned property on March 1, 20 L.
�e oi aop�rani qCE�ezs ol a0dc+n1 l��e� �%��L �7 Yale. arN ZIPa0e7
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ITY AUDITOR
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