Age_Forss .t�." ':4. APPLICATION FOR SENIOR CITIZEN
����• t� COUNTY TOWNSHIP YEAR
t' PROPERTY TAX BENEFITS
• -/ State State Form 43708(R16/1-23) (/,.,
\ ' � Prescribed by the Department of Local Government Finance `-� %b Son ?a--otc Tovvt (3
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 that apply)
�!1 Over 65
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?
s ❑ No
Name of Contract Seller Has Applicant Owned or Bought the Property Under Recorded Contract for at Least
One(1)Year before Claiming Deduction? des ❑ No
Address of Contract Seller(number and street,city,state,and ZIP code) Is the Property in Question:
❑"''Real Property ❑ Mobile Home(IC 6-1.1-7)
Taxing District Key Number/Legal Description Record Number Page Number
;POIcitAke..1 a0-0y^A - Boa- coo • 6-71- e>,-70
Does Applican e t 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?
[PK; El No ( QMGyk-eG..cF IL F D
Have You Filed for Deduction in Any Other County? If Yes,What County?
❑Yes 12<o NOV 2 2 2023
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
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Address of Applicant(number and street,city,state,and ZIP code)
005 $ W eS•k- 5 F P0,.toV-c, _-,,,,) g7G6 ce
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)
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DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer \