Age_Couts .50,R�.„. APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
i PROPERTY TAX BENEFITS I
/' State Form 43708(R15/1-20) ��� 2 a
� '' Prescribed bythe Department of Local Government Finance d O !/'v
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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
Type of benefit requested(Please c eck all that apply)
Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of ap l (owner or contract bu er)
,(tkCk 6
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 that of applicant,indicate below. Do all joint tenants or tenants in common reside on the property?
III Yes El 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 El No
Address of contract seller(number and street,city,state,and ZIP code) Is property in question:
Real property ['Mobile home(/C 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
Ong 2--C'\ ;—(8.301— O00.23O—OO
Does applicant reside on p rty? Assessed value of the property as of current year assessment date(May not exceed$200,000 for Over 65 Deduction or$199,999
Yes ❑No (counting just the homestead site]for the Over 65 Circuit Breaker Credit received before January 1,2020,and$199,999(all Indiana real
property]for the Over
individual's spouse.)See reverse for details.
Have you filed for any other de u ons? If Yes w adeductions?
Yes ❑Noc
Have you filed for deduction in a other county? If Yes, at county?
❑Yes ❑No
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of a plicant Date(m nth, ay,year)
Address of applicant (number and street,city,state,and ZIP code)
Signature of authorized representative Date(month,day,year)
Address of authorized representative (number and street,city state,and ZIP code)
Signature of County A 'tor (c.. .)?
Date(moth, y,year)
-" FILED
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�� ,� DEC 15 2023 0
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ISTRIBUTION: Original-County uditor; File-Stamped Copy-Taxp Qi. �
SON COUNTY AUDITOR