Age_Patterson ��,^^*� APPLICATION FOR SENIOR CITIZEN (COUNTY TOWNSHIP YEAR
PROPERTY TAX BENEFITS
,1.1440.P. �' State Form 43708(R15/1-20)
'� Prescribed by the Department of Local Government Finance v� 009
v ��
File Mark
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
Type of benefit requested(Please h k all that apply)
Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Na a of applica t or con r ct u r) Rctik_eks
Is applicant h ole le ale 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 that of 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 been buying 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) a property in question:
Real property ❑Mobile home(IC 6-1-1-7)
Taxing district 0C� Key number/Legal description
26-23--06 --24O -OoO . N4G^a Oq Record number Page number
Does applicant reside on property? Assessed value of the property as of current year assessment date(May not exceed$200,000 for Over 65 Deduction or$199,999
❑Yes III No [counting just the homestead site]for the Over 65 Circuit Breaker Credit received before January 1,2020,and$199,999[all Indiana real
p ay)for the
Yes ❑No SS I�Q�) 1 i
Have you filed for deductions y other county? If Yes,what county?
t •
❑Yes ❑No
I/We certify under penalty of perjury that the above and foregoing information is true a/d;. .
�Signaturecfr,_.applicantiTh
/ Date(mrh,d y year ��
cA t:. (_l�lJ. (t(.(.( h� IL � Il if
A dress of applicant (number and street,city,state,and ZIP code)
6co3 S ctkin kie t\-a,.JD .r)- (-0-639
Signature of authorized representative r Date(month,day,year)
Address of authorized representative (number and street,city,state,and ZIP code)
Signature of County Auditor 1 Date(month,day, ead �3
fn\•'LdC-1/C'
\S C-?\ ) q 1 I
FILED
NOV 1 6 2023
DISTRIBUTION: Original=1G6u y&n nITYFUgtlarPrAd Copy-Taxpayer