Age_Morrison (2) Reset Form
4 APPLICATION FOR SENIOR CITIZEN
.eli
COUNTY TOWNSHIP YEAR
47— - PROPERTY TAX BENEFITS
State Form 43708(R18/9-24) 6 i&N d 4-6KA, QS'
Me'6 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 loc e .
Filing Date: Form must be completed,signed,and filed with the county auditor or postmarked by Janua 5 o e ale r e., - • .
which the property taxes are first due and payable. .
.:. .9q1 .1•40j..c.
See reverse side for additional instructions and qualifications.
Type of Benefit Requested(Please check all that apply)
'tKOver 65 Deduction from Assessed Valuation CI Over 65 airtlit Breaker Credit
Name of Applicant(owner or ntract buyer)
Owned with Joint Tenant or Tenant in Common,Itidicate with Whom
V4Yes 0 No
If Name on Record is Different than Applicant Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property?
liYes CI No
Name of Contract Seller Has Applicant Owned or Bought the Property Under Recorded Contract for at Least
One(1)Year before Claiming Deduction? CI Yes 1No
Address of Contract Seller(number and street,city,state,and ZIP code) , Is the Property in Question:
XReal Property CI Mobile Home(IC 6-1.1-7)
Taxing District Key Number/Legal Description Record Number Page Number
-60i allicrod c, 6— /cZ—/p— .61-00/, 34 ,--6, g
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,
Yes 0 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
$
annually adjusted.]See reverse for details.
Have You Filed for Any Other Deductions? If Yes,Wirt sductions?
IYes CI No
Have You Filed for Deduction in Any Other County? If Yes,What County?
CI Yes No
IMie certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of Applicant j Date(month,day,year)
)1
Address of Appfic.g(Rnbe d street,city,stall ZIP c.Alr'- r
'1 CQq i R/AZ-' ,..,,,, Aide—7 0 All /kJ 47(070
Signature of Authorized Representative / Date(month,day,year)
Address of Authorized Representative(number and street,city,state,and ZIP code)
SignIf Coun Auditor Date(month,d y,year)
/(1 ailtid t-166'6"baib i
o6---/miaca... 4130
(,,,.........
A .
DISTRIBUTION: Original—County Auditor;File-Stamped Copy—Taxpayer
' I
1 -11 jr11)1