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Age_Hoover <'-"'-' APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR Ittr 1 PROPERTY TAX BENEFITS 0.� T� State Form 43708(R16/1-23) 0 J V► ` 23 '•'• ✓ Prescribed by the Department of Local Government Finance • 01 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 ec all that apply) Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit Name of Ap lican\(o.wner or contr t b ere) Owned with Joint Tenant or Tenant in Common,Indicate with Whom ❑ Yes ❑ No If Name on Record is Different than Applicant,Indicate Below Do All Joint Tenants or Tenants in om on Reside on the Property? Yes ❑ No Name of Contract Seller Has Applicant Owned or Bought the Property nde 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 th P erty in Question: eal Property ❑ Mobile Home(IC 6-1.1-7) Taxing District Key Number/Legal Description Record Number Page Number V� 2CrkU-1 $-zoI - on0 . 11i 1 - 001- Does Applican 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 Yes No Cam{' Have You Filed for De uc' n in Any Other ? If Yes,What County? ❑Yes No I/We certify under penalty of perjury that t above and foregoing information is true and correct. ' Signnaature of Applicant ` Date(month,day,year) Address p�number r:40 4111, d ZIP code) 6© �,,9 �� o I ov G-}-3 —L3`� . Signature of Authorized Representative Date(month,day,year) Address of Authorized Representative(number and street,city,state,and ZIP code) Signature of Count Au FILED Date(month,day, ear) SEP 0 7 2023 `` DISTRIBUTION: Original—County Auditor; File-Stamped Copy—T '� aglf/ZOUNT'Y AUDITOR