Age_Heldt -0""• APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP A YEA
,'�t- ' a� PROPERTY TAX BENEFITS --
State Form 43708(R16/1-23) �.kot(�.
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'•.•--- Prescribed by the Department of Local Government Finance IOWv� ht�
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 flied 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)
L Over 65 Dedu .,' from Assessed
If Owned with Joint Tenant or Tenant in Common,Indicate with Whom
Z Yes LJ 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?
!'4es = No
Address of Contract Seller(number and street.city.state.and ZIP code) Is the Property in Question.
LE Real Property Mobile Home(IC 6-1.1-7)
Taxing District Key Number/Legal Description Record Number Page Number
kZwns ? aG-I1-aq- o-oba. O y- Oa3
Does Appl c Property? Assessed value of the property as of current year assessment date(May not exceed 3240.000 for Over 65 Deduction or
_ 3199,999(counting just the homestead site)for the Over 65 Circuit Breaker Credit received before January 1,2020,and 5199.999(al
No Indiana real property)for the Over 65 Circuit Breaker Credit initially applied for after December 31,2019.)See reverse for details.
Is the Applicf Age or More on December 31 of the Year Pnor
Have You Filed for Any Other//Deductions? If Yes.What Deductions'
L�Yes ❑No 1-10/ie5+eaGtJ
---- -- --------- FIED
—H ____,.
ave You Filed for Deduction in Any Other County? If Yes.What County?
Dyes 2": DEC 2 9 2023
UWe certify under penalty of perjury that the above and foregoing information is true and correct. V
cant r —--
J ' _ ►�\I; 7 GIB O COUNTY AUDITOR
Add-ess of Applicant(number and street,city.state.and ZIP code)
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ture of Authorized �(� /
presentative � 7�- Date(month,day,year) -
Address of Authorized Representative(num er and street.city.state.a ZIP code)
Signature of Count Auditor I Date(month.day.year)
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DISTRIBUTION: Original—County Auditor; File-Stamped Copy—Taxpayer