Age_Williams `"'r'4. APPLICATION FOR SENIOR CINO -
COUNTY TOWNSHIP
ell= PROPERTY TAX BENEFITS YEAR
i State Form 43703(R16 l? 1 % V1, �, 1 ZO 1 �
,t'_,... Prescribed by the Department of L ice!Gc✓er^ ,_ Fna-. P� �(�er� I Z t
M
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-33-61
l/I ��w0� 4 00D
INSTRUCTIONS: To be filed in person or by mail with the c a 1lo&'ty where the property is located.
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Filing Date Form must be completed and signed by Decen $�9and 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 a"that apply)
VOver 65 Deduction from Assessed Valuation —firer 65 Circuit Breaker Credit
,i-ne.o'Appl.ca ro,v^ c,c-^tract huyer,
.What is His If Owned r. a ;•Te^a Co^ inn,Indicate with Whom- Yes ✓No I `I a 1 rJ •1 S-1'er, 600
i If Name on Record is D fferent than Applicant,Indicate Below Do All Joint Tenants _- Reside on the Property
i
Yes No
Name et Cort-act Salle Has.Applicant Owned cr Bougrt the Property Under Recorded Contract for at Least
ll I One(1)Year before Claiming Deduction% 1ES _ No
Address of Co r t Seller(number and street c;ty state and ZIP code' Is the Property in Quest on-
I _✓Real Property _ Mobile Home(IC 6-1.1-7)
Taxing District 'Key Num er;Leal Descr;• I Record Number Page Number
\-1.1\\Oln . 'a - g 1 I_ C'3 ' CC I . 133-CD5
Does Applicant Reside on Property? Assessed value of the property as of current year assessment date(May not exceed S240,000 fcr Over 65 Deduction or
_ S199.999[counting just the homestead site]for the Over 65 CircuitBreaker Credit received before January 1.2026 and S199.999[a,
:111.es — No Indiana real property]for the
Have Ycu Filed for Any Other eductions? If Yeess,,What Deductions% -- L-
�l
Yes ❑No
[-Have YOU F led fcr Deduction in Any Other County? If Yes.`NhCounty?
1
❑yes IIIL•P‘
IA Ve certify under penalty of perjury that the above and foregoing information is true and correct.
i S:gna±ure of Applicant I Date(month. day.year)
As of Appl c t(number and street cty state and ZI ode)
JK v1""1
Signature of Authorized Representati.e Date tmontn day year)
I
Address of Authorized Representative(number and street.c ty.state and ZIP code — — ---
S 9^a'-re o`Co_ ty A,;d'or --
Dote(month day year,
DISTRIBUTION: Original -County Auditor. File-Stamped Copy-Taxpayer
""'4 APPLICATION FOR SENIOR CITi [ COUNTY ! TOWNSHIP YEAR Fes. • ` PROPERTY TAX BENEFITS 1-1 !--
t
. � State Form 43708(R15/1-23, LED1
• Prescribed by the Department of L cal G vemr;ent F na c<_ L
��p� 4,ng, 1
Information contained in this document is CONFIDENTIAL pursul�6�.�649.
INSTRUCTIONS: To be filed in person or by mail with ounty audi-of lye county1where the property is located. ` Doc)
Filing Date: Form must be completed and signed by p�6 ft HONE } NjRcounty 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
T,P a of Benefit Requested(Please check a!' t apply) ----- .-1
-
ver 65 Deduction from Assessed Valuation "Over 65 Circuit Breaker Credit
Name Apo!ca__ contract buyer; ;
-, . . If Ownedvi t- -^t Tenant or Tens-'- Common Ind;-ate with Whom
_ Yes :1;0( I ''
If Name on Record is Different than Applicant.Indicate Below, Do All Joint Tenants or Te-.: is in Comma side on the Property '
fCYe--- s 7 No
Name of Contract Seller l Has Applicant Owned or Bougr t the Property Under Recorded Contact for at Least
Ore(1)Year before Claiming Deduction? -
- es _ No
Address of Contract Seller(number and street city state and ZIP code' Is the Pr rty in Question
Real Property _ Mobile Home(/C 6-1.1-7)
Taxing D strict Key Number!Legal Description Record Number Page Number
Does Appfc t Res- on Property? Assessed value of the property as of current year assessment date(May n:r :,:--J 5240,000 fcr Over 65 Deduction or
_ S199,999(counting just the homestead site]for the Over 65 Circuit Breaker Credit rece-ved before January 1. 2026. and 5199,999(al Yes _ No Indiana real property]for the
', - -
es ❑No
-------------- — -
Have You Fled for Deduction in Ary Other County? I If Yes,Wha.County? — -- - - - -El yes Yes o
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
i --
I S,gnai re of Apppliccaannt 2j lelf �nn,�_ j Date(month. day year;
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Addess of Appl'cant(number nd street city state.and ZIP ode)
L eo . • 1 Sr-t-.T -- --O. 0'. , J4Q , Lk -) U �t.k
Signature of Authorized Representative ••
Date(month. day.year)
Address of Authy¢ed Representative(number and street.cty.state and ZIP code — - -- -
i-
S 9^a' e o Coty A T d for ^ - Date(month, day years - -
)3.61...")
7
0.
.- I a....
DISTRIBUTION: Original-County Auditor, File-Stamped Copy-Taxpayer