Age_Hill ,-,'w APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
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PROPERTY TAX BENEFITS
'iratifr;;/ State Form 43708(R16/1-23) v�D.() D2 8 2�
•'•- 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 of Benefit Requested(Please chec all that apply)
Over 65 Deduction from Assessed Valuation I Over 65 Circuit Breaker Credit
e of App leant(owner or contra t ,yer) mil Address
Is Applicant the Sole Legal or Equitable Owner'? If No.What is His/Her Exact Share or Interest? If Owned with Joint Tenant or Tenant in Common.Indicate with Whom
L; Yes L 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 Has Applicant Owned or Bought the Property Under Recorded Contract for at Least
One(1)Year before Claiming Deduction? _ Yes 7 No
Address of Contract Seller(number and street.city.state.and ZIP code) Is he roperty in Question.
Real Property _ Mobile Home(IC 6-1.1-7)
Taxing District 0 � Key Number;Legal Description 8 Record Number Page Number
• 24 - 12 -07- 2,-t -o0.1.30) - 02 ,
Does Applicant e e on Property'? Assessed value of the property as of current year assessment date(May not exceed S240,000 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 Applica 65 ar of Age or More on December 31 of the Year Prior
Have You Filed for Any Other Deductions?yfJoitiI If Y s,What Deductions?
XYes J ,Have You Filed for D du ion in Any Other If s.What County'?
❑Yes No , Pit ,
UWe certify under penalty of perjury t at th above and foregoing information is true and correct.
Signature of Applicant Date(41140 day.year ty
Address of Applic umber and street.city. ate. nil ZIP code,I Gjes 2oz."
•
Signature of Authorized Representative/ 1 Date(rriJr�r�� r)
Address of Authorized Representative(number and street.city,state,and ZIP code)F.1
i
Signature of oanty Auditor (..-;
I Date(month. d )(eorj
DISTRIBUTION: Original—County Auditor; File-Stamped Copy—Taxpayer