Age_Rains Reset Form
y"N. APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
4 .li,'-1j ft PROPERTY TAX BENEFITS ` CC � n(� ``�
�..:- Stale Form 43708(R18/9-24) J� O l�C�J
~' Prescribed by the Department of Local Government Finance
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. , VVV
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
❑ 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? ly) Yes ❑ No
Address of Contract Seller(number and street,city,state,and ZIP code) Is
the Property in Question:
!!!T Property ❑ Mobile Home(IC 6-I.1-7)
Taxing Dis et Key Number/Legal Description Record Number Page Number
2.4s
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 fall
Indiana real property]for the Over 65 Circuit Breaker Credit initially applied for after December 31,2019 and before January 1,2023,
Yes El 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 Applica t 65 ars of Age or More on December 31 of the Year Prior
es El No FILEiD
Have You Filed for De u ion in Any Other oun 7 If Yes, at County?
❑ Yes No APR 2 9 2025 c.>,
I/We certify under penalty of perjury t at a above and foregoing information is true and correct.
Signature of Applicant .�f D le month,day,year)
KM/.U,o K R,irnn � `/ % SON C OR
Addre of Ap tic nt number and street, ity,state,and IP code)
‘I �e W 1 iv-, -J`O- 1-0--6 iv.
Signature of Authorized Representative Date(month,day,year)
Address of Authorized Representative(number and street,city,state,and ZIP code)
SignaMture off Coun Auditor Date( onth,da year)
c) \ — 5 Xt r-/iC2-I----
DISTRIBUTION: Original—County Auditor;File-Stamped Copy—Taxpayer
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