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Age_Bye Reset Form es^";".'� APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR i ''I PROPERTY TAX BENEFITS State Form 43708(R18/9-24) SC n 0 0s- 2 '°'• 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,signed,and filed with the county auditor or postmarked by January 15 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 c ec II that apply) Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit /jn orcona bur) 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 roperty in Question: eal Property ❑ Mobile Home(IC 6-1.1-7) Taxing District Key Number!Legal Description // Record Number Page Number 0 d ) 2 11-161-'h2--bo o. 0({2_-0 0c 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,$199,999[all Indiana real property]for the Over 65 Circuit Breaker Credit initially applied for after December 31,2019 and before January 1,2023, At'es El No and$239,999[all Indiana real property]for the Over 65 Circuit Breaker Credit initially applied for after December 31,2022.)See reverse for details. Is the Applicanars of Age or More on December 3 of the Year TOTAL $ annually adjusted.]See reverse for details. Have You Filed for Any th Deductions? If Yes, hat eductions? Yes ❑ No • Have You Filed for De ion in Any Other Coun 9 If Yes, at County? ❑ Yes Na I/We certify under penalty of perjury at t e above and foregoing information is true and correct. Pi/ 47) Signatur of nl Date(month,day,year) f Address of Applicant( ber and stre41nd ity, ZIP code) \ ^� I ©3 9 �3 S _,\ivs I fi s0 q L11 i' L1 [� • `©S Signature of Authorized Representative / Date(month,9 ,9i7.f- • Address of Authorized Representative(number and street,city,state,and ZIP code) COvQ �p4ToR Si ature o ounty udilor Date( onfh, ay,year) DISTRIBUTION: Original—County Auditor;File-Stamped Copy—Taxpayer