Age (2) - 4, n:,s. APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
PROPERTY TAX BENEFITS
,.j State Form 43708(R16 I 1-23) G I D SO y, rAo 4°)pm lrvf ' y
-'^!% 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 locate
Filing Date: Form must be completed and signed by December 31 and flied with the countyauditor orpostmark y t t�
y e o owing
January 5 of the calendar year in which the property taxes are first due and payable.
See reverse side for additional instructions and qualifications. FEB 09 2024
Type of Benefit Requested(Please check a that apply)
_ Over 65
Owned with Joint Tenant or Tenant in Common,Indicate with Whom
__ Yes E. No
If Name on Record is Different than Applicant,Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property?
__:-. .--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?
_ Yes n No
Address of Contract Seller(number and street.city. state.and ZIP code) Is the Property in Question
I Property Z. Motile Home(IC 6-1.1-7)
Taxing District Key Number i Legal Description Record Number Page Number
/v.o(\iSoM.erk. a(Q — 17-4 7- 00o--coo 1. 37/- 0 D‘
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
j1Yes ❑No 140Ivia571-el
Have You Filed for Deduction in Any Other County?_/! If Yes,What County?
ID yes I�'No !
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Date(month,day.year)
' -9 a /
�,/li�--- r �c t
A ress of Applicant(num er and street.city. tate.and ZIP code)
G54q S L050 (,J Owe,n ��1� N '� G4
ini
nre of Authorized epre ntative I Date(month.day.year)
Address of Auth ed Representative(number and street,city,state.and ZIP code)
Signature of County Auditor Date(month. day yea')
L � A) .� a/'97 41
DISTRIBUTION: Original—County Auditor; File-Stamped Copy—Taxpayer