Age_Harrington APPLICATION FOR SENIOR CITIZEN
COcUNTY TOWNSHIP YEAR
PROPERTY TAX BENEFITS
State Form 43708(R16/1-23) 9(3c},r 00 +
MI6 Prescribed by the Department of Local Government Finance i
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
_.
Type of Benefit Requested(Please k all that apply)
(Please
Over 65 Deduction from Assessed Valuation
Nape of Applicant(own1 r or paqtr t b yer) Telephone Number Over 65 Circuit Breaker Credit
ail Address
Ci\V\0Wk i
iVN
Is Applicant the Sole Le al or Equitable r? If No,Wh is His/Her Exact Share or Interest? If Owned with Joint Tenant or Tenant in Common,Indicate with Whom
E Yes 0 No
If Name on Record is Different than Applicant,Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property?
0 Yes 0 No
Name of Contract Seller Has Applicant Owned or Bought the Property Under Recorded Contract for at Least
One(1)Year before Claiming Deduction? 0 Yes 0 No
Address of Contract Seller(number and street,city,state,and ZIP code) Is t P o)Serty in Question:
eal Property 0 Mobile Home(IC 6-1.1-7)
Taxing District Key Number/Legal Description Record Number Page Number
- 2 - 3_ 0,1__ 00 . s'3L1-00-* .
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
5199,999[counting just the homestead site]for the Over 65 Circuit Breaker Credit received before January 1,2020,and$199,999[al
0 Yes E No Indiana real property]
Have You Filed for Any oth• a eductions? If Yes,Wh c‘liss? "( li
IN Yes El No
Have You Filed for D.ducti.n in Any Other Co If Yes,What Co nty?
C. o
El yes
e. ..._.>:
illAle certify under penalty of perjury t at th above and foregoing information is true and correct. 6'04,4"er_r., eeeo,
CIO, c2
Signature of Applicant Date(montny,d/a4.340
Am' I, iiciAnlia#Dii •)-,
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t n. ,,, ,:.icant(nu t•es et city,state,and ZIP co 1 ) .7... _,\ fi',-,i7-1•li
Signature of Authorized Representative 1 Date(month,day,year)
Address of Authorized Representative(number and street,city,state,and ZIP code)
Sign rim Date(monthlyear)
Csql
\1 115K \2- • 'L- 7 ..
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer