Age_Davis (2) s"''a. APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
`.A ' ` PROPERTY TAX BENEFITS -11
State Form 43708(R16 I 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 located.
Filing Date: Form must be completed and signed by December 31 and flied 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 Requested(Please h ck all that apply)
I I
Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
N e of Applic nt wner or cortr t b er)
If Owned with Joint Tenant or Tenant in Common.Indicate with Whom
Yes a No
If Name on Record is Different than Applicant,Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property?
_ Yes 7 No
Name of Contract Seller I Has Applicant Owned or Bought the Property Un ecorded Contract for at Least
One(1)Year before Claiming Deduction? es 7 No
Address of Contract Seller(number and street,city.state.and ZIP code) I the Property in O stion:
' Real Property 7L_, Mobile Home(IC 6-1.1-7)
Taxin District Key Number i Legal Description Record Number Page Number
Z�� 26 - l,-) -300-voa ,ti19-3 ,02 3 ,
Does Appllca t Re ,de 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
filed a joint return with the individuals spouse)See reverse for details. pTv_ $
Have You Filed for Any Other Deductions? If e . at eductions?
Yes El No ittf__,) '
Have You Filed for D uct in Any Other Count ? If Yes, at County? FF
❑Yes No a
3
lANe certify under penalty of perjury t at t above and foregoing information is true and correct. C7eSON�+,� O��
Sig lure of Applicant Date(rif'" /I�id r)
. (2
O
AdP4Jt.c of Applcant(numbd state.and ZIP code) R
g2‘A ok S 2 25—wD cJ'l — 3' ) .
Avii. •uthorized Representative I Date(month,day.year)
,A.. sTAuthorized Representative(numbe and street.c .state.and ZIP code)
Signature of County Auditor I Dat�m/o th. da ye ) l A
DISTRIBUTION: Original—County Auditor; File-Stamped Copy—Taxpayer