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Age_McEllhiney ,,`r APPLICATION FOR SENIOR CITIZEN y aa. �OUNTY TOWNSHIP YEAR PROPERTY TAX BENEFITS kl 304 0 t1 State Form 43708(R16/1-23) --'a 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 c ec II that apply) • Over 65 Deduction from Assessed Valuation • Over 65 Circuit Breaker Credit Na e of Applicant(owner or cont ct b er) Owned with Joint Tenant or Tenant in Common.Indicate with Whom Yes a No If Name on Record is Different than Applicant,Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property? .— Yes 71 No Name of Contract Seller Has Applicant Owned or Bought the Property Under Recorded Contract for at Least One(1)Year before Claiming Deduction? , :2-Tes Li No Address of Contract Seller(number and street,city.state,and ZIP code) Is the Property in Question: 1 'Real Property �. Mobile Home(IC 6-1.1-7) j Taxing District Key Number/Legal Description Record Number Page Number PR)neti n_ 2_6 -/2-- ©7-2.61- . y6R- S Does Appl;cant Reside on Property? Assessed value of the property as of current year assessment date(May not exceed$240,000 for Over 65 Deduction or Ye _ $199,999[counting just the homestead site]for the Over 65 Circuit Breaker Credit received before January 1.2020,and$199,999[a! i s No Indiana real property]for the l _ Have You Filed for Any Other Deductions? If Yes,/Whha`t,D�edductions? 4 Yes ❑No 1L11��lea _ O Have You Filed for Deduction in Any Other County? If Yes,What County? a ` ❑Yes No W o � Ifv e certify under penalty of perjury that the above and foregoing information is true and correct. C `1 Z I Si lure of Applicant Date(month,day.year _ ml i 1 I Addre of Applicant(number and street,city.s d IP code) O '7/.3 /1r iQa cv, /�� �fz � svz� � r 44-710-7 d co Signature of Authorized Representative ;Date(month,day.year) j Address of Authorized Representative(number and street.city,state.and ZIP code) Signature of County Auditor i Date(month,day.year) L `7')/Cc_e_ Al ) -ki/c2 C 471-5 2co a DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer ....„--"\----