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Age_Hoskins
' ',a. APPLICATION FOR SENIOR CIEE L �yD CO NTY TOWNSHIP YEAR PROPERTY TAX BENEFITS L State Form 43708(R16/1-23) � .:,.....,.. _ .4,.... • I�.i.� Prescribed by the Department of Local Government FinancP0 4 20249LS-v) 00 G �� I Information contained in this document is CONFIDEf�Vfg}j py�rsuant to I�C,66-1.1Y-35-9. INSTRUCTIONS: To be filed in person or by mail where the property is located. AVOITf�c Filing Date: Form must be completed and signed by December 31 and filed-Rh 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 Over 65 Circuit Breaker Credit I m of Applicant( virper or contra b er),V If Owned with Joint Tenant or Tenant in Common.Indicate with Whom _ 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 7 No Name of Contract Seller Has Applicant Owned or Bought the Property Under corded Contract for at Least One(1 j Year before Claiming Deduction? s —I No Address of Contract Seller(number and street.city.state.and ZIP code) Is the Property in Question. sal Property ; Mobile Home(IC 6-1.1-7) Taxing District Key Number/Legal Description Record Number Page Number OO G 26-t124-300- o©o .Sig -o C 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 the homestead site]for the Over 65 Circuit Breaker Credit received before January 1.2020,and S199,999(al Yes _J 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 ear of Age or More on December 31 of the Year Prior Have You Filed for Any Oth r Deductions? 1 If Y s,What ctions?�W Yes ❑No 3 tAK ,Have You Filed for D uc on in Any Other Co nt ? If es.What Co ❑Yes No I/We certify under penalty of perjury that the above and foregoing information is true and correct. ignature of plicant 1 Date(month,day,year) ?„...„ I ddress of Applicant(number and street,city.state.and ZIP code) i I Signatwgof Authorize epresentative ^ Date(month,day,year) //\c„\ ddress of Authorized Representative(number and street.city,state.and ZIP code) S'gnature of County ditor I crl Date/mont . day.year) DISTRIBUTION: Original—County Auditor; File-Stamped Copy—Taxpayer