Age_McKinight APPLICATION FOR SENIOR CITIZEN
C,�UNTY TOWNSHIP YEAR
i 1 PROPERTY TAX BENEFITS 1 (� �2
',, 0 00 .
a� State Form 43708(R16/1-23) n
JPrescribed 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 ed.
Filing Date: Form must be completed and signed by December 31 and filed with the county auditor or post eTb he fo in
January 5 of the calendar year in which the property taxes are first due and payable. i-`J i I
See reverse side for additional instructions and qualifications. JUN
2 7 21124
Type of Benefit Requested(Please ec I that apply)
Over 65 Deduction from Asses d luation recill3SOPCOkUe:TrYe'dit—
Over
Nam f Ap icant(own r r c nt ct bu
If Owned with Joint Tenant or Tenant in Common,Indicate with Whom
Yes ❑ No
If Name on eco 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 U er ecorded Contract for at Least
One(1)Year before Claiming Deduction? Yes ❑ No
Address of Contract Seller(number and street,city,state,and ZIP code) Is the Property in Q scion:
eal Property ❑ Mobile Home(IC 6-1.1-7)
Taxing District Key Number I Legal Description Record Number Page Number
Does Applica Re ide on Property? Assessed value of the property as of current year assessment date(May not exceed$240,000 for Over 65 Deduction or
$199,999(counting just the
exceed:(1)$30,000 for individuals who filed a single return;or(2)$40,000 for individuals who
filed a joint return with the individual's spouse.)See reverse for details. AL $
Have You Filed for Any Ot er Deductions? If're Deduc ons? .
Yes 0 No -S •' i
Have You Filed for edu tion in Any Other unty? If Yes, hat Cou ty?
❑Yes No
I/We certify under penalty of perjury that t e above and foregoing information is true and correct.
Sign a of Applicant Date(monthd ,year 221
&. m 2:
Addressddl� of Applicant(rirruber an fate,and ZIP col) ^t ��.,n
l l S ., S 6 l�� (V� ,t J
Signature of Authorized Representative ) Date(month,day,year)
Address of Authorized Representative(number ands street,city,state,and ZIP code)
Signature of County Audi r J Date(month,da ,year) I
mU�� bras �� 6 �� \f„.. 2......1..)
DISTRIBUTION: Original—County Auditor; File-Stamped Copy—Taxpayer