Age_Lecocq Reset Form
s "'TM% APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
0 -'` PROPERTY TAX BENEFITS
1 State Form 43708(R18/9-24) rff, ,rt/�l 'I/�a! c25
'" 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 ca n T
which the property taxes are first due and payable.
See reverse side for additional. s In truchons
If Owned with Joint Tenant oiTerieruiv6om with Whom
X1 Yes ❑ No AV�]rOR
If Name on Record is Different than Applicant,Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property?
XYes ❑ No
Name of Contract Seller Has Applicant Owned or Bought the Property Un er corded Contract for at Least
One(1)Year before Claiming Deduction? Yes ❑ No
Address of Contract Seller(number and street,city,state,and ZIP code) Is the Property in Question:
Cl, - A Real Property ❑ Mobile Home(IC 6-1.1-7)
Taxing District Key Number/Legal Description Record Number Page Number
006 Z -f4-IQ- 63 -ODD, r26 .-DD&
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,$199,999(all
Indiana real property]for the Over 65 Circuit Breaker Credit initially applied for after December 31,2019 and before January 1,2023,
spktes ❑ No and$239,999(all Indiana real
Have You Filed for Any Other Deductions? If Yes,Wh ductions? �1 ,p
- Yes ElNo �,+ `( t_C .._-
Have You Filed for Deduction in Any Other County? If Yes,What County?
❑ Yes ❑ No
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of Applicant Date(month,d/e year) �L
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ddress of A licantcant(n�scree,city,state,ar IP code)
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��&8 & iwe �� a t i4-0 1 i , I� irgZ 2 —1//4
Signature of Authorized Representative Date(plonth,day year)
Address of Authorized Representative(number and street,city,state,and ZIP code)
Signs re ftount Auditor J
. Date(month,dear)
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=r�4 33 � �o-1s
DISTRIBUTION: Original—County Auditor,File-Stamped Copy—Taxpayer
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