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Age_Perry APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR PROPERTY TAX BENEFITS • v„ • a� State Form 43708(R16/1-23) l , 1\950 n Q 0(V• 702.3 ,,• 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 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. . Type of Benefit Requested(Please c eck all that apply) Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit Name of Applicant(9wger or contr t b er) Telephoned Number Em it Address Is Applicant the S e Legal or E itable Owner? If No,What is His/Her Exact Share or Interest? If Owned with Joint Tenant or Tenant in Common,Indicate with Whom Yes ❑ No If Name on eco 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 the Property in Questi n: Real Property ❑ Mobile Home(IC 6-1.1-7) Taxing District Key Number/Legal Description \ Record Number Page Number COG . 2 -13-It- 300-00�0. �63 -O0 6 Does Applicant side 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,and$199,999(al Yes ❑ No Indiana real property]for the Over 65 Circuit Breaker Credit initially applied for after December 31,2019.)See reverse for details. Is the Applica 6 Year of Age or More on December 31 of the Year Prior $ Have You Filed for Any Other Deductions? If Yes,What Deducti ns? Yes El No C.Sl k Have You Filed for Deducfton in Any Other County? If Yes,What County? ❑Yes X‘lo INVe certify under penalty of perjury that the above and foregoing information is true and correct. Signature of Applicant Date(month,day,year) , �Lll.y 2i z0Z3 Address of pplicant(number and street,cit state,and ZIP code) 2-'6 S t0 ro E o` d C0 -06 - 1\46 6'0. Signature of Authorized Representative Date(month,day,year) Address of Authorized Representative(number and street,city,state,and ZIP cod Signature of Count Auditor FtLEDDatetd?IYear) o2- 3 JUL 2 1 2023 a. DISTRIBUTION: Original—County Auditor; File-Stamped CopGigrjUNTY AUDITOR