Age_Nash �'%'-='� APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
�i \a'1 PROPERTY TAX BENEFITS
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State Form 43708(R16/1-23) nso v1 ,V1 CQ,j0K d�
Z• 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. TT
Filing Date: Form must be completed and signed by December 31 and filed with the county auditor or postmarked th1fo win
January 5 of the calendar year in which the property taxes are first due and payable. 11
See reverse side for additional instructions and qualifications.
AUG 14 2023
Type of Benefit Requested(Please check all that apply) ��
Over 65
.3VAUDITOR
Is Applicant the�Solele�Legal or Equitable Owner? If No,What is is/ er xact Share or Inter st? If Owned with Joint Tenant or Tenant in Common,Indicate with Whom
L�'Yes ❑ No
If Name on Record is Different than Applicant,Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property?
O'fes ❑ No
Name of Contract Seller Has Applicant Owned or Bought the Property Under Recorded Contract for at Least
One(1)Year before Claiming Deduction? C'Yes ❑ No
Address of Contract Seller(number and street,city,state,and ZIP code) Is the Property in Question:
[eal Property ❑ Mobile Home(IC 6-1.1-7)
Taxing District r Key Number/Legal Description Record Number Page Number
RC\nc. h %-Q-ctg-Io3- 001.313
Does Applic t Re ' e 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
$
Have You Filed for Any Other Deductions? If Yes,
What Deductions?
Ekes ❑No 1- C71v‘eS�er
Have You Filed for Deduction in Any Other County?� If Yes,What County?
❑ Lr ry Yes o
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of Applicant .^ 'Date(month,day, ar)
Address of Aap1jLan mber and street, te,and ZIP code) i (
5.18 C GG SO►t r I ACRAon L 4) G70
Signature of Authorized Representative Date(month,day,year)
Address of Authorized Representative(number and street,city,state,and ZIP code)
Signature of County Auditor Date(month,day,year)
Pl.)" c --t_, 8//s/P3
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer