Age_Reeves '•a. APPLICATION FOR SENIOR CITIZEN
OUNTY TOWNSHIP YEAR
;�i- PROPERTY TAX BENEFITS _ --
' State Form 43708(R16/1-23) SO
1�
[ ?___ 7/24..
'..:--" 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) t
I Over 65 Deduction from Assessed Valuation ver 65 Circuit Breaker Credit
I —
me of Applicant(owner or cor , t .uyer)
If Owned with Joint Tenant or Tenant in Common,Indicate with Whom
`; Yes No
1 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 ecorded Contract for at Least
1 One(1)Year before Claiming Deduction? Yes 71 No
Address of Contract Seller(number and street,city. state.and ZIP code) Is the Property in Question.
Xeal Property `; Mobile Home(IC 6-1.1-7)
Taxing District Key Number I Legal Description Record Number Page Number
029-- 26- 12- os boo- 901- 3 -02.9-
Does Applican Re ' eon 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 S199,999(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 Appli ar of Age or More on December 31 of the Year Prior
Have You Filed for D du
Yes El No S
on in Any Other Cou
nty? If Ye .What County?
❑yes IANe certify under penalty of perjury that he above and foregoing information is true and correct.
Sig of Applicant)(
Date(mon . day, ear
2/ (1/° --k
Address of Applicant(number an street,city.state.and ZIP code) -
FILED i
ig re A t razed Repr sentative ` ^ ` Date(month.day,year)
Address o uthorized R res tative(number and street.city,state,and ZIP code)APR 02
2024
Signature of ou Au i r .- �s % LAC j y` ' at (mo th_day year_ )
/�iAYiL+evred/ Z r4)43
j I G113-SON-COSH TY AUDITOR
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer