Age_Hawkins ,"T' q. APPLICATION FOR SENIOR CITIZEN
��_ � CQUNTY TOWNSHIP YEAR
PROPERTY TAX BENEFITS 1
State Form 43708(R16/1-23) S Q n/1
'ir!:.> Prescribed by the Department of L�c,,l GcoE- ,:Fne-CB
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(Pleas c ck all that apply) --
ver 65 Deduction from Assessed Valuation ver 65 Circuit Breaker Credit
it Name of Applicant(owner Cr contract buyer)
If Owned with Joint Tenant or Tenant in Common,Indicate with Whom
C•CYes L_ No
If Name on Record is afferent than Applicant,Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property?
— Yes 77 No
Name of Contract Seller
Has Applicant Owned or Bought the Property nder R rded Contract for at Least
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
1
I - ! I Property Mobile Home(IC 6-1.1-7)
Taxing District .Key Number i Legal Description Record Number Page Number
'RI/icU.0n ! 26.-a- 07 i - ac7. 33V-ozr . •
Does Applicant Reside 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 1,2026.and$199.999 fat
LZ•ce--s--
— 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 Decemb r 31 of Year Prior
'O
Have You Filed for Any Other Deductions? If YesWhhaatt DeductDeductions", '4
v- , o
Yes El No If'/iiiY/1eJJerQc.aL 4.4 o_ CV_ a
I Have You Filed for Deduction in Any Other County? ' If Yes,What County? I-
e H
❑Yes No Z
0
Li
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IlWe certify under penalty of perjury that the above and foregoing information is true and correct. .Q Z
i Sign of Applicant Date(month.day.year)
O
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• Address of Appl cant Irumber and street sty state and ZIP code)
32' )1/ E ta2_. C& c1t _A (��.- L)-767. 31
I Signature of Authorized Representat.- Date(month.day.year)
Address of Authorized Representative(number and street city.state and ZIP code)
S n .•ur of County Aud.tor - Date .
L t1?i hc jai s,A 4- 5-2.o2 4L ._
DISTRIBUTION: Original-County Auditor: File-Stamped Copy-Taxpayer çjç/