Age_Brownell Reset,Form
"' APPLICATION FOR SENIOR CITIZEN c�igTJ r O YEAR
- ' ' PROPERTY TAX BENEFITS 1 L A•yam%f State Form 43708(R18/9-24) t to,^ 2QZ-,�r
ram Prescribed by the Department of Local Government Finance J FEB
04 2025
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 Ja eale�r i
which the property faxes are first due and payable. GIB ON COUNTY AUDITOR
See reverse side for additional instructions and qualifications.
Type of Benefit Requested(Please chec all that apply)
a Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
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?
Ly'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? [14,4s ❑ No
Address of Contract Seller(number and street,city,state,and ZIP code) Is the Pro rty in Question:
LT Real Property ❑ Mobile Home(IC 6-1.1-7)
Taxing District Key Number/Legal Description Record Number Page Number
Does Applicant Reside on Prop&rty? 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,
l 'es ❑ 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 Applicant 65 Years of Age or More on December 31 of the Year Prior
y Yes ❑ No H. 5
Have You Filed for Deduction in Any Other County? If Yes,What County?
❑ Yes OK;
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signatu f Applicant Date(month,day,year)
Address of A plicant(number}.street,city,state,and ZIP code)
/
1 � ,f !te 1/-6, .
Signature of Authorized epresentative JJ Gr(7Gh ,}`Date(month,day,year)
c7Ul - /t/- /57L ^ c/ ��veNSvl i/e -CIV
Address of Authorized Representative(number and street,city,state,and ZIP code)
Signature of Couety Auditor ' Date(month,day,year)
L j)(P&IeCt4
C .
DISTRIBUTION: Original—County Auditor;File-Stamped Copy—Taxpayer