Age_Midkiff 44`"""4.• APPLICATION FOR SENIOR CITIZEN
., COUNTY TOWNSHIP YEAR
iztd y PROPERTY TAX BENEFITS
`' State Form 43708(R16/1-23) 6 t b Sp in ?r\nCe t on g/1
t.i...- 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 check all that apply)
_1/C)ver 65 Deduction from Assessed Valuation _lc�Over 65 Circuit Breaker Credit
Name of Applicant(owner or contract buyer)
If Owned with Joint Tenant or Tenant in Common,Indicate with Whom
LYes No
1 If Name on Record is Different than Applicant.Indicate Below Do All Joint Tenants or Tenants in Common� Reside on the Property?
1 Yes 7 No
Name of Contract Seller Has Applicant Owned or Bought the Property Under Recorded Contract for at Least
l One(1)Year before Claiming Deduction? _"yes Ell No
Address of Contract Seller(number and street.city.state.and ZIP code) Is the Property in Question
V-r-‘r\c.Qko n dal Property LT Mobile Home(lC 6-1.1-7)
Taxing District Key Number;Legal Description Record Number Page Number
2 -la-o?- ?oy- 003_. .(0a6 - bat
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$199,999(al
,des _ No Indiana real property]for the Over 65 Circuit Breaker Credit initially applied for after December 31, 2019.)See reverse for details.
Is the Applicant 65 Year of Age or More on December 31 of the Year Prior
Have You Filed for Any Other Deductions? If Yes,What Deduction �`
es El No
No / !M S IS4`1p%\� —
Ak f1Q--- ,
Have You Filed for Deduction in Any Other County? If Yes,What County? '
❑Yes (2 No I
UWe certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of Applicant Date(month,day.year)
...._
ApAA. , vi, ,p_o a di
Address of Applicant(number and street,city.state.and ZIP co �{
61 5 v 1'n*Q^SOY1 54- ? 11C&F k . 17l 70
Signature of Authorized Representative I Date(month,day,year)
1
Address of Authorized Representative(number and street.city,state.and ZIP code)
•Signature of unty Auditor____ ...k\IA.Nr....., i!/' _ i FILED Date(month.day.year) --
APR 17 2024
GI
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer
BSON COUNTY AUDITOR