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Age_Wester (2) /'"%74N. APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR i �:7,1 PROPERTY TAX BENEFITSriS\ Stale Form 43708(R16/1-23) `� ��� .� �.t 702 'e1e Prescribed by the Department of Local Government Finance 1 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. 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 chec all that apply) . Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit ame of Applic nl(pwneror ontra t b ey r) Address Is Applicant th Sole Legal or ' ble Owner? If No,What is His/Her Exact Share or Interest? If Owned with Joint Tenant or Tenant in Common,Indicate with Whom ❑ Yes ❑ 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 R corded 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 th P perry in Que ion: eat Property El Mobile Home(IC 6-1.1-7) Taxing District Key Number/Legal Description Record Number Page Number 0 26 -12-Ix_voU--001. o (Z -02'2 Does Applicant Re 'de 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 Yes ❑ No Indiana real property)for $ Have You Filed for Any Other Deductions? If Yes,Wha.D uc* s? es ❑No Have You Filed for Ded ct n in Any Other C u y? If Yes, a C nty? ❑Yes No I/We certify under penalty of perjury t at t e above and foregoing information is true and correct. Signature f Applicant .....).../.7 ` Date(month,day,year) a �- 1/ - zV Address of Applicant umber and street,cit ,state,and ZIP code) Cg01-1 �Ohi© sfi V'� r► '-3n- kAM 9-'0 . Signature of Authorized Representative/ Date(month,day,year) Address of Authorized Representative(number and street,city,state,and ZIP code) Signature of County Audi r IF I L ' ,, T,' Date( nt ,day,year) NOV 04 2024 0 DISTRIBUTION: Original—County Auditor; File-Stamped CoPY01f$9SVJOUNTY AUDITOR