Age_Hardin �M`""' APPLICATION FOR SENIOR CITIZEN
/� � a COUNTY TOWNSHIP YEAR
%¢ PROPERTY TAX BENEFITS (qj-
\ % State Form 43708(R16/1-23) G tb50n Vl� all
-i !— 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 that apply)
Over 65 Deduction from Assessed Valuation ✓ Over 65 Circuit Breaker Credit
Name of Applicant(owner or contract buyer)
Owned with Joint Tenant or Tenant in Common,Indicate with Whom
u Yes ❑ No
If Name on Record is Different than Applicant,Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property?
- Yes E No
Name of Contract Seller Has Applicant Owned or Bought the Property Under Recorded Contract for at Least
One(1)Year before Claiming Deduction? 'J Yes E No
Address of Contract Seller(number and street,city,state,and ZIP code) Is the Property in Question:
//�� , L ' al Property E Mobile Home(IC 6-1.1-7)
Taxing District ) (y Number/Legal 2c, _0(.2_ go_300 _000. , `19 017
k'
Description
Record Number Page Number
Does Applicant Re 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
p yes El No kkolivec -ead FEB 0 6 2024
Have You Filed for Deduction in Any Other County? If Yes,What County?
❑Yes Loco iV
I/We certify under penalty of perjury that the above and foregoing information is true and correct1BSON (N AUDITORY t
Signature of Applicant Date(month,day,year)
Address of Applicant(nu ber and street,city,state,and ZIP code)
6? 7 e 35o AI Fresco s pi ill 6111
Signature of Authorized Representative Date(month,day,year)
Address of Authorized Representative(number and street,city,state,and ZIP code)
Signature of County Audito, / Date(month,day.year)
1-1116
AM
DISTRIBUTION: Original—County Auditor; File-Stamped Copy—Taxpayer