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Age_Peach APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR cr PROPERTY TAX BENEFITS `._ 1� �`b nrr tD111469 a lo State Form 43708(R16/1-23) Ge r�L. 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. /0 /1. ' #0..._ f/ Filing Date: form must be completed and signed by December 31 and filed with the ` E "Over 65 Deduction from Assessed Valuation LH"Over 65 Circuit Breaker Credit Name of Applicant(o er or contract buyer) Email Address (i Is Applican the ore Legal or Equitable Owner? If No,What i H' H t Share or Interest? If Owned with Joint Tenant or Tenant in Common,Indicate with Whom G2"Yeg�s ❑ No ED If Name on Record is Different than Applicant,Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property? JUL 9 [�d'1 ❑ No Name of Contract Seller `3 2nn Has Applicant Owned or Bought the Property Hite ecorded Contract for at Least 1 zec� 7• One(1)Year before Claiming Deduction? Yes ❑ No Address of Contract Seller(number and street,city,sta�I,® e� / Is the Prope in Qu : • \�1 Pb1, C'NTYA J eat Property ❑ Mobile Home(IC 6-1.1-7) Taxing District Key Number/Legal Description (J©]rO/Z Record Number Page Number A e aO -(-)-U4tAtD _c .3 -Eck Does Applic ' e on Pro rty? 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 homestead site]for the Over 65 Circuit Breaker Credit received before January 1,2020,and$199,999[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 Applic nt 65 ar of Age or More on December 31 rof the Year Prior Have You Filed for Any Other ''Deductions? If Yes, h t Deductions? E es El No � , Have You Filed for Deduction in Any Other County? If Yes,What County? ❑Yes pifNo ' I/We certify under penalty of perjury that the above and foregoing information is true and correct. Signature of Applicant Date(month,day,year) (--311.1 - I e Qa.e.k t•A'-' C \t" °I` % PeLAZ-Vi's 11 --CD3 -.Q LI . oaa in liernber andistTeLay,state, nit ZIP code) 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) '' nn `Ic a s CIm I n(1 .\Dni-tu,L0 _ `-1 -a�c `4 - DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer