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.7.{.. APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
14,-.--,-.: 1 PROPERTY TAX BENEFITS
... ,.., State Form 43708(R18/9-24) 9,30,, 0-2.1
(... Prescribed by the Department of Local Government Finance
' Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. ( bri ‘Aft 0
INSTRUCTIONS: To be filed in person or by mail with the county auditor
ail Address
Is Applicant 4 ,j,Ie Legal or Equitable Owner? If No,What is His/Her Exact Share or Interest? If Owned with Joint Tenant or Tenant in Common,Indicate with Whom
es 0 No
If Name on ecord Different than Applicant,Indicate Below Do All Joint Tenants or Tenants In Common Reside on the Property?
ID Yes El N o
Name of Contract Seller Has Applicant Owned or Bought the Property nder R rded Contract for at Least
One(1)Year before Claiming Deduction? Yes 0 No
Address of Contract Seller(number and street,city,state,and ZIP code) I the roperty in Question:
Real Property 0 Mobile Home(IC 6-1.1-7)
Taxing District Key umber/Legal Description Record Number Page Number
0 1 . '-11.—I (3-3 co b 00. _S-5"9- 0 .
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 fall
Yes Indiana real property]for the Over 65 Circuit Breaker Credit initially applied for after December 31,2019 and before January 1,2023,
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 Oth Deductions? If Yes,What eductions? %-
es 0 No 1 foi)
Have You Filed for D cli n in Any Other Co ntyfly'?edix
If Yes,WhatLS-ounty?
.k - C4irl c
0 Yes o
INVe certify under penalty of perjury that the above and foregoing information is true and correct.
Sigrplalaexf Applicant
Date(month,day,PILED
Address of/1kplicant(number and street,city,state,and ZIP code)
1-201 S 1 00 0(AD
Signature of Authorized Representative Date(month,day,year) MAR 2 8 2025
Address of Authorized Representative(number and street,city,state,and ZIP code)
't h a 4 1 a,1 i 6 6.. ,3 4)
Signature,of Count Auditor _ Date(mo fh,day, ON COUNTY AUDITOR
--D 3 day,
•
DISTRIBUTION: Original—County Auditor;File-Stamped Copy—Taxpayer