Age_Knight .,; '!-4q. APPLICATION FOR SENIOR CITIZEN
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{ COUNTY TOWNSHIP YEAR
•
i. PROPERTY TAX BENEFITS /
`..,;.:;, .Viip.: ..7 State Form 43708(R16/1-23) 111
.!S'..%- Prescribed by the Department of Local Government F'na-ce O �� 2.- {
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. ( •
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Type of Benefit Requested(Please check al!that apply) •
Over 65 Deduction from Assessed Valuation ���Over 65 Circuit Breaker Credit
Name of Applicant(owner or contract uypr)-
If Owned with Joint Tenant or Tenant in Common,Indicate with Whom
X; i— No
If Name on Record is Different than Applicant,Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property?
76-"<s. 77 No
Name of Contract Seller 1 Has Applicant Owned or Bought the Property U er ecorded Contract for at Least
N ` P► One(1)Year before Claiming Deduction? Yes E No
Address of Contract Seller(number and street city state and ZIP code) Is the Property in Ques on
I �
eal Property E Mobile Home(/C 6-1.1-7)
Taxing District 'Key N mber 1 ai Description Record Number Page Number
\A�l 1 I,3r\ L a Lo- t` -. uk , Li 0 a - colo .s.as -oa.�
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
� �� _ 5199.999(counting just the homestead site]for the Over 65 Circuit Breaker Credit received before January 1,2020,and S199,999 fat
_VYes - No Indiana real property]for
$ -
Have You Filed for Any Other Deductions? I If Yees hat ductions?
0 No •
i Have You Filed for Deduction in Any Other County' If Yes.What County? 1 —�
❑Yes [D,vao O4100 /y-�
I/We certify under penalty of perjury that the above and foregoing information is true and correct. UQ` ' 1VO l
Signature applicant iteif__,2,.ebdcf2__ _________. iDate(m el?day.year)
4 - I k -a 4 .
Ad ress of pplicant(number and street.city.stale. nit ZIP code)
. 0 ‘LO cc Ca ) , )-+71>/\- -e—lh \..a/t , Lk—I _Ctq
Signature of Authorized Representative ' Date(month. day.year)
Address of Authorized Representative(number and street.city.state.and ZIP code)
S c-raa:•e a`County Auditor Date(month. day year,
` ti-,0._sL-a_. a. 31,3--t_L_ yy -1 l a --1 _
G.......)5\f\)
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer