Age_Snyder (2) ` :',4., APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
'A \' PROPERTY TAX BENEFITS
'',.-.'Wv iq State Form 43708(R16/1-23) 1'On / ZV 0(- 3
-Mil 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.
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 c ec all that apply)
Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Nary—EApplicant( r or contr b er)
•
Is Applicant the Sol4gal or w able 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 Record 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? r Yes ❑ No
Address of Contract Seller(number and street,city,state.and ZIP code) Is a operty in Question:
Real Property ❑ Mobile Home(IC 6-1.1-7)
Taxing District Key Number/Legal Description IC) Record Number Page Number
0 2 -0,07-I-I0g- 0 Li 2SU'62g .
Does Applic Re a on Property'? Assessed value of the property as oiturrent year assessment date(May not exceed$240,000 for Over 65 Deduction or
$/99,999(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
$
Have You Filed for An Ot er Deductions? If Y at Deductions?
Yes ❑No S
Have You Filed for D uc n in Any Other C unty? If Yes, hat County?
❑Yes o
I/We certify under penalty of perjury t t th above and foregoing information is true and correct.
Signature of p licant /)d ('/// Date(month.day,year)
ddress of pplicant(n er and street,cityate,and ZI co e)
(2 —SSow s P�� r �`n �1�
Signature of AuthoZ-)1/
Representative 1 Date(month,day,year)
Address of Authorized Representative(number and street,city,state,and ZIP )
L ��
Signature of County Auditor, ..( Date(m nth.day. ear)
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DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer q�� R