Age_Blaize �``r,; a APPLICATION FOR SENIOR CITIZEN couN Y T 7 YEAR
i • ' PROPERTY TAX BENEFITS - —
i S' V�i�4 /Ziv a r"
State Form 43708(R16/1-23) Gi 'b s0✓t .214
0 5 2024
'°'!%• Prescribed by the Department of Local Government Finance AP r
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. y�� � I
INSTRUCTIONS: To be filed inperson ormail with the county auditor of the countywhere the property is 1%'/l�DN COUNTY�/�� �
by p p Y R5€ DN AUDITOR
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.
i Type of Benefit Requested(Pleas ch k all that apply)
I
Over 65 Deduction from Assessed Valuation • Over 65 Circuit Breaker Credit
II
Name of Applicant(owner or contract bu r)
If Owned with Joint Tenant or Tenant in Common.Indicate with Whom
t'es ` 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 Recorded Contract for at Least
One(1)Year before Claiming Deduction? F '2S _ No
Address of Contract Seller(number and street,city.state.and ZIP code) Is the Property in Question
XReal Property Mobile Home(/C 6-1.1-7)
Taxing District Key Number/Legal Description Record Number Page Number
W./A& /16 _05 -58 -005 - ooa . Alai -a/ &
Does Appl. nt R ide on Property? Assessed value of the property as of current year assessment date(May not exceed$240,000 for Over 65 Deduction or
_ S199.999[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 Applican ear of Age or More on December 31 of the Year Prior
$
Have You Filed for Any Other Deductions? If Yes,What Deductions?
Yes ❑No .5,
Have You Filed for De uct on in Any Other County? If Yes.What County? —_I
I
❑Yes o
on nri,,n n 111A11n rorfifii nrinr n .�In.of n .Hs,.�}.n L.n.,n anrt fnrcnninn inform ofinn in fro",-,nrl r rrur•f
Sign a of Applicant Date(month, day.year)
�
Address of Applicant(number and street,city.state. ZIP code) � G
Signature o Authorized Representative Date(month, day.year)
1
1
C Address of Authorized Representative(number and street.city,state.and ZIP code)
Signa,ure o'Co:nty Auditor I Date Imont day.year;,..iy.1 .4.,:i.e..) z i i ex j6eezx<:) /....9....i.
C.....
DISTRIBUTION: Original-County Auditor, File-Stamped Copy-Taxpayer