Age_Theys APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
PROPERTY TAX BENEFITS
Ili‘t State Form 43708(R15/1-20)
"• iira--",:' Prescribed by the Department of Local Government Finance -301 0 (I+ 2__2
File Mark
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 filed 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 ck all that apply.) x1
Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name o itkilSjilant(owne or con ract yer)
Is applicant the s e le I or equitable own ? If No,wha ' his/her exact share or interest? If owned with joint tenant or tenant in common,indicate with whom.
0 Yes El No
If name on record is different than that of applicant,indicate below. I Do all joint tenants or tenants in common reside on thelproperty?
El Yes UN°
Name of contract seller Has applicant owned or been buying the property under recorded contract for
at least one(1)year before claiming deduction?
111 Yes D No
Address of contract seller(number and street,city,state,and ZIP code) I 'e property in question:
. Real property "'Mobile home(IC 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
247-I 2_-(9 -q,<,)—0 b0 3\Ct - 0 2-4- .
Does applicant reside on pro e y? Assessed value of the property as of current year assessment date(May not exceed$200,000 for Over 65 Deduction or$199,999
es [11 No ("grooupnetdinyljfourst theeohvoemr gs5tebairdcusittekefoaritchere )rveedriti5in5itlycuaitpBprlieeadkfeorr Carffeedritoreecceemivrerbrr2e0/a97ae-/i.e2v0e2rs0,eafnord details.l99999[all Indiana real
Is the applicant 65 years o ag or more on Dec ber 3/of the
$
Have you tiled for any other d u ions? • If Ye
individual's spouse.)See reverse for details. St deductions?
Yes ON° .
Have you filed for deductions n y other o nty? If Ye ,what county?
Xt
['Yes No
_41
I/We certify under penalty of perjury t at the above and foregoing information is true and correct.
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Signature f applicant ....../...„,,, Date(month,day,var)
(\Address o...f li (num•71ndTtreet,city, ate,and ZIP co e) .
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20 Z ike_ 5 ThAto oc) ''' .>
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Signature of authorized representative Date(month,day,year)
Address of authorized representative (number and street,city,state,and ZIP code)
Signature of CouM itor 10A 0---2... (--(-C Date(month,d
3 ...5•
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MAR 2 8 2023
GAzeizeziLiBsoN COUNTY AUDITOR
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer