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47, APPLICATION FOR SENIOR CITIZEN
6rt 7-'-'1:-\A PROPERTY TAX BENEFITS
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-4.0..) State Form 43708(R15/1-20)
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• ---4 Prescribed by the Department of Local Government Finance
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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 check all that apply.)
015;er 65 Deduction from Assessed Valuation [1}1:5;e765 Circuit Breaker Credit
Name of applicant(owner or contract buyer)
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Is applicant the sole legal or equitable owner? If No,what is hjslher exact share or interest? If owned with joint tenaL or tenant in common,indicate with whom.
0 Yes M'No 1 .3
I If name on record is different than that of applicant,indicate below. I Do all joint tenants or tenants in common reside on the prbperty?
Ei Yes glcro
Name of contract seller Has applicant owned or been buying the property under recorded contract for
V-S\ at least one(1)year before claiming deduction?
IIPre-s- I:]No
Address of contract seller(number and street,city,state,and ZIP code) Is the property in question:
2<a!property 0 Mobile home(IC 6-1-1-7)
Taxing district ,Key number/Legal description
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Does applicant reside on property? Assessed value of the property as of current year assessment date(May not exceed$200,000 for Over 65 Deduction or$199,999
[counting just the homestead site]for the Over 65 Circuit Breaker Credit received before January 1,2020,and$199,999[all Indiana real
InPre's No property]for the Over
individual's spouse.)See reverse for details. .
Have you filed for any other deductions? If Yes what deductions'?As 0 No I -tb
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Have you filed for deductions in any other county? If Yes,what county? -?0
Dyes IRK-o
I/We certify under penalty of perjury that the above and foregoing information is true and correct. CO/r2
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Address•,./pplicant (number and street,city,state,and ZIP code)
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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 County Auditor
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