Age_Wilkerson ��� `_"-4. APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
/R;:�' " 1;4'' PROPERTY TAX BENEFITS
,� `; State Form 43708(R16/1-23) t 1_ f'r`n C�k-c, a
!•.• Prescribed by the Department of Local Government Finance �7 , 1
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 t t apply)
ver 65 Deduction from Assessed Valuation ver 65 Circuit Breaker Credit
Name of Applicant(owner or contract buyer)
Is Applicant the Sole Legal or Equitable 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?
2 Yes ❑ No
Name of Contract Seller Has Applicant Owned or Bought the Property Under Recorded Contract for at Least
�Y1(,.. One(1)Year before Claiming Deduction? es ❑ No
Address of Contract Seller(number and street,city.state,and ZIP code) Is the Property in Question:
l [al Property E Mobile Home(IC 6-1.1-7)
Vzing District Key Number/Legal Description Record Number Page Number
r:‘ ce— 0[0- - IP - 1 - 000. `-kat - OcD
Does Applicant Reside on Property? Assessed value of the property as of current year assessment date(May not exce d$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
es ❑ No Indiana real property)for the Over 65 Circuit Breaker Credit initially applied for after December 31,2019.)See reverse for details.
Is the Applicant 65 Year of Age or More on December 31/of the Year Prior
ii)
Have You Filed for Any Other Deductions? If Yes,What Deductions?
Yes El No w- `► l__,S O
Have You Filed for Deduction in Any Other County?? If Yes,What County? 23
El Yes Ltfnto (3fBS0'tom �,J -3.
I/We certify under penalty of perjury that the above and foregoing information is true an c ect. N COON "'v
ro
Signature of Applicant '2,...3 ljt f _ Date(month,day.year�nf r�
'A dress of Applicant(number and street,city,state,and ZIP code) \ )--- U2 - .ac. .
‘Iso (-1 . z. -P,J, ,:isiii ,9_ , P,) ---(}- __4•0_0 .., . 'Ai Q-Lo .
Signature of Authorized Representative ) Date(month,day,year)
Address of Auth zed Representative(numbest,city,state,and ZIP code)
i
Signature of County Auditor Date(month,day,year) 1
\ e�a�Q a . LA t) \L, /./y\ zst.D \\- u - ��
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer ) \