HomeMy WebLinkAboutAge_Jines a-<C'`"""s.. APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
1.
! PROPERTY TAX BENEFITS
�, . State Form 43708(R16/1-23)
!•..-- Prescribed by the Department of Local Government Finance
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 locat .
Filing Date: Form must be completed and signed by December 31 and filed with the county auditor or postmarked by y/na
January 5 of the calendar year in which the property taxes are first due and payable.
See reverse side for additional instructions and qualifications. tii, I oV FEB O- ?424
Type of Benefit Requested(Please check that apply) 311....§?3-43 ,
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Over 65
Owned with Joint Tenant or Tenant in Common,Indicate with Whom
13/Yes ❑ No
If Name on Record is Different than Applicant,Indicate Below Do All Joint Tenants or Tenants in Commmoo�Reside on the Property?
•J Yes E No
Name of Co ract Seller Has Applicant Owned or Bought the Property Under Recorded Contract for at Least
One(1)Year before Claiming Deduction? Yes ❑ No
Address of ContractContract •Seller(number and street,city,state,and ZIP code) Is the Prop in Question
eal Property E Mobile Home(IC 6-1.1-7)
i Taxing District Key Number/Legal Description Record Number Page Number
Pr',v\C \-O.( ate- \ ,-Q-1- D O — 00 ' 2—1S—G
Does Applicant Re90iion 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
er:iYes E No Indiana real property]
Have You Filed for Any Other Deductions? If Yes,Wh t Deductions?
Yes ❑No
Have You Filed for Deduction in Any Other County? If Yes,W at County?
El Yes No
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of��Apppliicant Date(month,day,year)
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dre pplicant(n b\er and trees, i and ZIP c C P
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Signature of Authorized Representative Gate(month.day,year)
Address of Authorized Representative(number and street,city,state,and ZIP code)
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Signature of County Auditor Date(month,day.year)
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DISTRIBUTION: Original—County Auditor; File-Stamped Copy—Taxpayer c�
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