Age_Hunt ."-:"4� APPLICATION FOR SENIOR CITIZEN
�� .: :., COUNT 16spo YEAR
ri.+� , 1i PROPERTY TAX BENEFITS M
State Form 43708(R16/1-23) Sd O V �'Zy
''• Prescribed by the Department of Local Government Finance M Y 17 2024 •
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 loi a.vY�
ON COUNTY 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.
Type of Benefit Requested(Please check that apply)
Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of Applicant(owner or contract buy r)
Exact Share or Interest? If Owned with Joint Tenant or Tenant in Common,Indicate with Whom
pYes ❑ No
If Name on Record is Different than Applicant,Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property?
❑ Yes ❑ No
Name of Contract Seller Has Applicant Owned or Bought the Property Under Recorded Contract for at Least
One(1)Year before Claiming Deduction? 'trYes ❑ No
Address of Contract Seller(number and street,city,state,and ZIP code) I the P erty in Question:
Real Property ❑ Mobile Home(IC 6-1.1-7)
Taxing District Key Number/Legal Description Record Number Page Number
Qa i4 — Li—I / - ; , - 000. 38/-oo7
Does Applicant Reside o Proper . Assessed value of the property as of current year assessment date(May not exceed$240,000 for Over 65 Deduction or
L1�'Y/ $199,999(counting just the homestead site]for the Over 65 Circuit Breaker Credit received before January 1,2020,and$199,999[al
es ❑ No Indiana real property]for the
?
Yes ElNo 1—�/ S
Have You Filed for De action in Any Other County? If Yes,What County'?
❑yes ilKo
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of Applicant , ) Date(month,day,year)
Address of Applicant(number nd street,city,state,and ZI code)
?('
'Lig V .'.--Fc,,- / 4 /.2D 6 ,L-1 ix/ 241 /czt)
•
Signature of Authorized Representative Date(month,day,year)
Address of Authorized Representative(number and street,city,state,and ZIP code)
Signature of County Auditor � Date(month,day,year)
( 'y
DISTRIBUTION: Original—County Auditor; File-Stamped Copy—Taxpayer