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Qs" "°w APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIPIIM
7 ='�` 1 PROPERTY TAX BENEFITS
•: yy ti% State Form 43706(R16 i 1-23) 6[A Ai ATX 4 C52
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.
Filing Date: Form must be completed and signed by December 31 and filed with the county auditor or postmarked by the foll ing 1
January 5 of the calendar year in which the property taxes are first due and payable. . ED
See reverse side for additional instructions and qualifications. Novi
r � 2024 �^�JJ
Type of Benefit Requested(Please check all that apply) / v
Over 65 Deduction from Assessed Valuation fif Over 65 Circuit Breaka�t��( /7
N�arke o A licant(owne con ct buyer) tiI�`
► Y AV DIT OgRJ
Is Applicant the Sole Legal or itable Owner? ,Whaf is His/Her Exact Share or Interest? If Owned with Joint Tenant or Tenant in Common,Indicate with Whom
I>S,Yes ❑ No
If Name on Record is Different than Applicant,Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property?
JYes ❑ No
Name of Contract Seller Has Applicant Owned or Bought the Property Under Recorded Contract for at Least
One(1)Year before Claiming Deduction? ❑ Yes gNo
,Address of
Contract� Seller(number and str encity,stale,aanddZIP7c�opde) I Is the Property in Question:
�'"l ? r (/) I-�-D !t,I N W f(/�+"1 �/�' ����� Lx,Real Property ❑ Mobile Home(IC 6-1.1-7)
Taxing District Key Number/Legal Description Record Number Page Number
(00T1 s4—I I-- 1S-ao&ov 16/-0r
Does Applicant Reside on Property? Assessed value of the property as of current year assessment date(May not exceed 5240,00p for Over 65 Deduction or
5199,999(counting just the homestead site]for the Over 65 Circuit Breaker Credit received before January 1,.2020,and S199,999(al
Yes ❑ No Indiana real property]for the
$
Have You Filed for Any Other Deductions? If Yes hat Deductions?
'Yes 0 No
Have You Filed for Deduction in Any Other County? If Yes,What County?
❑yes b-No
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Sign applicant Date(moot ,day,year
Address of Applicant(number and street,city,st a and ZIP code)
, 11 W J(wZi2 IQ IAICE7V/d( 141 '4-7670
Signature of Authorized Representative Date(month,day,year)
Address of Authorized Representative(number and street,city,state,and ZIP code)
Sign t re of County Audi or r Date(month,day,Yea ct LI
„0,177
DISTRIBUTION: Original—County Auditor; File-Stamped Copy—Taxpayer .