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Age_Creek (2) 7 Res'et�Form �"4, APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR 14-0-7-.. 1.•1 PROPERTY TAX BENEFITS 1 .` State Form 43708(R18/9-24) CT C 0" ©21 �//� tam Prescribed by the Department of Local Government Finance J ��/ 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.Ceor‘ck10 See reverse side for additional instructions and qualifications. (y��A Type of Benefit Requested(Please ec. all that apply) Over 65 Owned with Joint Tenant or Tenant in 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? ❑ Yes ❑ No Name of Contract Seller Has Applicant Owned or Bought the Property Under Recorded 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 th Property in Question: Real Property El Mobile Home(IC 6-1.1-7) Taxing District Ke umber/Legal Description �� Record Number Page Number - I1-G--ti00- 3I.Vg,-02k Does Applican Reside on Property? Assessed value of the property.s of current year assessment date(May not exceed$240,000 for Over 65 Deduction or $199,999[counting just the homesfeed 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, Yes ❑ No and$239,999[all Indiana real property]for the Over 65 Circuit Breaker Credit initially applied for after December 31,2022.)See reverse for details. Is the Appli t 6 Years of Age or More on Decemb r 3 f the Year Prior $ annually adjusted.]See reverse for details. Have You Filed for Any 0 r Deductions? If Yes,W t ductions? ' Yes ❑ No ` :4 . Have You Filed for D uc n in Any Other Con If Yes, t County? ❑ Yes No I/We certify under penalty of perjury th t the bove and foregoing information is true and correct. '�/©� Signature of Applicant /� / Date th,day,year) Oa �,��,,,,�,��jJ/// w_LPG tip/f��t_" ! des �/` K O Address Applicant( bai and sties state,andZIP code) �� ry Z S •-\- J'n- c°GQ eee��yyyyyy,,,��'��' Signature of Authorized Representative i Date(month,day,year)'`7(� �r09 Address of Authorized Representative(number and street,city,state,and ZIP code) Signature of unty for Date ph, a year) 01 .kvs 'Li 2 - DISTRIBUTION: Original—County Auditor;File-Stamped Copy—Taxpayer