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Age_Wilson Li `-`m" APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR PROPERTY TAX BENEFITS _ State Form 43708(R16/1-23) ��/� Au 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 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) 0 Over 65 De lion from Assessed Valuation CI Over 65 Circuit Breaker Credit _ Name of Applicant(ow r or contract buyer) Yes Nl,d o 100 Wife,Joyce A Wilson If Name on Record is Different than Applicant,Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property? Wilson,James R/Joyce A © Yes ❑ No Name of Contract Seller Has Applicant Owned or Bought the Property Under Recorded Contract for at Least One(1)Year before Claiming Deduction? ['es illE No Address of Contract Seller(number and street,city,state,and ZIP code) Is the Property in Question: ❑r Real Property ❑ Mobile Home(IC 6-1.1-7) Taxing Districo Key Number/Legal Description Record Number Page Number Patel t 26-11-12-103-002.429-028 Alternate ID 1112E101019/025 00-7135 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 ❑ 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 Have You Filed for Deduction in Any Other County'? If Yes,What County?Dyes El No Eli) I/We certify under penalty of perjury that the above and foregoing information is true and correct. S nature of Applicant Date(month,da FLs�) 0 5 2024 t xc7 , 1/30/2023 C Y r•C\ Address pelican num rand street,city,state,and ZI code) 209 N rth Ave Princeton, IN 47670 2 nio� 1 a, na) Signature of A thorized Representative Date(moon h,day y9MNTY AUDITOR Address of Authorized Representative(number and street,city,state,and ZIP code) Signature of County Auditor Date(month,day,year) .1\k-N‘d --11 -61—t 0 Ct. , . ."-- 4- V-- ,1,_D I 4-\!). .),_ . 1w D ,,..„, ti„,„,,, „:„..,,,.,„ ..-, JAN 3 0 2023.c_c_ DISTRIBUTION: Original—County Auditor; File-Stamped Copy—Taxpayer ib a1vj