Age_Fears 1'
``"' fArl_a. APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
ti41 : 1 PROPERTY TAX BENEFITS
i State Form 43708(R19/7-25) G i bso Washington 2025
244," 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 locate .
Filing Date: Form must be completed, signed, and filed with the county auditor or postmarked by January 15 of the Galen e r i
which the property taxes are first due and payable. NO
See reverse side for additional instructions and qualifications. Q
045
Type of Benefit Requested (Please check all that apply) Ci/e
Sp
✓❑Over 65 Credit ❑✓ Overpjre.�al�t Credit
Name of Applicant (owner or contract buyer)
Owned with Joint Tenant or Tenant Common, Indicate with Whom
['Yes ❑ No
If Name on Record is Different than Applicant, Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property?
N/A 0 Yes ❑ No
Name of Contract Seller Has Applicant Owned or Bought the Property Under Recorded Contract
N/A for at Least One(1)Year before Claiming Credit?
❑Yes ❑✓ No
Address of Contract Seller (number and street, city, state, and ZiP code) Is the Property in Question:
N/A p Real Property ❑ Mobile Home (IC 6-1.1-7)
Taxing District Key Number/ Legal Description Record Number Page Number
Washington 26-05-12-100-000. 188-017
Did Applicant qualify for the homestead standard deduction in the preceding year (or was applicant married 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 Prior to the Year Taxes are First Due& Payable? ❑✓ Yes ❑ No
Signatu ppl'. Date (month, day, year)
M t rr , l,. / ir O ll / t� / ate
Address of Applicant (number and street, city. state, and ZiP code)
6355 N. Nixon Rd, Hazleton, IN 47640
Signature of Authorized Representative Date (month. day, year)
Address of Authorized Representative (number and street, city, state. and ZIP code)
Signature of County Auditor Date (month, day. year)
Q C . , b_A--\L„,0,), ,k - ,o _ a�
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DISTRIBUTION: Original - County Auditor; File-Stamped Copy - Taxpayer