Age_Corn e" a• APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
PROPERTY TAX BENEFITS
. ,� State Form 43708(R16/1-23) 064
fai!% 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 flied 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)
?'Over 65 Deduction from Assessed
If Owned with Joint Tenant or Tenant in Common.Indicate with Whom
�
'il es i No
i 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 I Has Applicant Owned or Bought the Property Under Recorded Contract for at Least
I One(1)Year before Claiming Deduction? No
I Address of Contract Seller(number and street,city. state,and ZIP code) Is the Property in Question.
I
eal Property a Mobile Home(IC 6-1.1-7)
I Taxing District Key Number I Legal Description Record Number Page Number
III, C . .9G-ly-‘g- Soy- ate. c2I -aM
Does Appfca - -.eon 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
Have You Filed for Any Other Deductions'? If Yes.What Deductions'? FILtD
aYes ❑No }`Olv‘e 54-e&Have You Filed for Deduction in Any Other County? If Yes.What County?
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❑Yes Erlo MAR 2 2 2024
I
IANe certify under penalty of perjury that the above and foregoing information is true and correct. �'./,
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Address of Applicant(n brand street,city.state.and ZIP co _)
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Signature of Authorized Representative ;Date(month,day.year)
Address of Authorized Representative(number and street.city.state.and ZIP code)
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Signature o!/1""V" d is ,^'/' Date(month. day,year)
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DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer