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Age_Hornick (2)
�^°""'a APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR it-• PROPERTY TAX BENEFITS a�`1,s; .•_;• State Form 43706(R16/1-23) 3fO'Y') © ITh • 2°24 . 'a'• Prescribed by the Department of Local Government Finance Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. / 1 V 1 11 Q- INSTRUCTIONS: To be filed in person or by mail with the county auditor of the county where the property is located. `,J __ 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.GO) Type of Ben-i '-.• - - heck all that appy)\` t , y III rl 0 Over= 'eduction fro ssessed Valuation Over 65 Circuit Breaker Credit Name of Applicant(owner or con!. f b. er) Is A..licant the Sole Legal or Equitable Owne If No,What is His/Her Exact Share or Interest? If Owned with Joint Tenant or Tenant in Common,Indicate with Whom , l ❑ Yes ❑ No If Name on Record is Different than Applicant,Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property? [] Ye , El No Name of Contract Seller Has Applicant Owned or Bought the Property nde 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) I th Property in Question: Real Property ❑ Mobile Home(IC 6-1.1-7) Taxing District Key Number/Legal Description Record Number Page Number 01-9- 2L-'02 57- 113-000 . SO -O R Does Applicant Reside 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 homestead site]for the Over 65 Circuit Breaker Credit received before January 1,2020,and$199,999(al A'es ❑ No Indiana real property]for $ Have You Filed for Any Other Deductions? If Yes,Wha)Deedductions? Yes El No l'y1 ` , • Have You Filed for De u ion in Any Other County? If Yes,WharCounty? 1\lo ElYes I/We ce ' un r penalty of perj thabove and foregoing information is true and correct. igna r o(Ap titan Diane( ont day,year) U\1 - . j(14442104 ddr s of Ap ' nt mb an sty et,city,st te,and ZIP code L ."I\ �2 Signature of Authorized epresentative 1 Date(month,day,year) Address of Authorized Representative(number and street,city,state,and ZIP code) 1` Signs re of ty Au itor Date(nyaGthidaye ) ` u .4.41:6 xpayer '0. O�