Age_Strader (2) '01"1":4,, APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
74 44.- PROPERTY TAX BENEFITS
a` ) State Form 43708(R16/1-23)
\`- / Prescribed by the Department of Local Government Finance &f�b�n -P�I ncerk w aq
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�bc
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. JAN 1 8 2024
See reverse side for additional instructions and qualifications. �y �/
Type of Benefit Requested(Please check all that apply) a.!i►
tBreaker CYeAUDITOR
�bver 65 Deduction from Assessed Valuation er 6N.CfreQt
Name of Applicant(owner or contrac�u epn cj e. Telephone Number Email Address
Is Applicant the
Solele 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
gi'Yes i❑ No
If Name on Record is Different than Applicant,Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property?
❑ No
Name of tract Seller Has Applicant Owned or Bought the Property Under Reco ed Contract for at Least
( ! One(1)Year before Claiming Deduction? Yes ❑ No
Address of Contract Seller(number and street,city.state,and ZIP code) Is the Prop rty in Question:
Real Property ❑ Mobile Home(IC 6-1.1-7)
Taxing District Key Number/Legal Description Record Number Page Number
errs e_4i0( . s , -t\4 _- ,>o ooi .g'le - Qa8
Does Applicant Reside 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 E 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
IS:4 Ile d
Have You Filed for Deduction in Any Other County? If Yes,What County?
❑Yes No
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature Applicant Date(month,day,year)
ie,e,6 (.._ ...azAk
gof Applicant(number and street,city,state,and ZIP ode)
Signature of Authorized Representative J•
Date(month.day,year)
Address of Authorized Representative(number and street,city,state,and ZIP code)
Signature of County Auditor Date(month,day,year)
‘\f\( 0' i' Cl 0_.Q a . L)LD2L4--\L„..,__ID ir\k&k,D . - (8(-sz c-(' , 1
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer \\/�
I..)/