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Age_Marvell (2)
"''� APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR �1 •1p'. 1 PROPERTY TAX BENEFITS /"� ,� P State Form 43708(R16/1-23) \, � 1 • )'o h 3024 ;* '"i" 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 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 ec all that apply) Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit Name of Applicant(owner or co tr b er) 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 Recorded 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 t e Property in Question: Real Property ❑ Mobile Home(IC 6-1.1-7) Taxing District Key Number/'Legal Description Record Number Page Number Does Applicant Reside on Property? Assessed value of the property as of current year assessment date(May not exceed$240,009 for Over 65 Deduction or $199,999[counting justthe,homestead site]for the Over 65 Circuit Breaker Credit received before January 1,2020,and$199,999(al Yes El No Indiana real property]for the Over 65 Circuit Breaker Credit initially applied for after December 31,2019.)See reverse for.detals. Is the Applica t 6 Year of Age or More on Decembe 31 f the Year Prior $ Have You Filed for Any Other Deductions? If Yes,What Deductions? 'Yes 0 No k ' Have You Filed for Drf uc n in Any Other County? If Yes,What County? ❑yes ❑No I/We certify under penalty of perjury that the above and foregoing information is true and correct. Sign t re of Applicant Date(month,day,year) lividn - 1 ^3 ty- 2a Q_LE Address of Appli t number and street,city,state,and ZIP code) S662 U325v NI -,n - y0-6OD . Signature of Authorized Representative Date(mom t year) .E" Ii' ; • Address of Authorized Representative(number and street,city,state,and ZIP code) .1 i# /+d� a Dale( ' n Sig nty Audi r © h ffai) • u`i� \t/' G'/,S�/ ZoZQ ay oQ _ 4V07 DISTRIBUTION: Original—County Auditor; File-Stamped Copy—Taxpayer