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Age_Lamar 04:4 Forll :"4'4. APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR fs ' PROPERTY TAX BENEFITS 1 .� State Form 43708(R18/9-24) I�©v, 0t-t.- , ,,..,, HIM 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 Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit N f Applicant(owner or cont ct er) Telephone Number _m 'I Address kati-� �ya y • ( ) Is Applicant the Sole 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 ❑ 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 der R rded 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 P operty in Question: eal.Property ❑ Mobile Home(/C 6-1.1-7) Taxing District 'Key Number/Legal Description Record Number Page Number OP— b6-o6- 700- ouo. d6c- oti- . 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, es ❑ No and$239,999 rail Indiana real property]for the Over 65 Circuit Breaker Credit initially applied for after December 31,2022.)See reverse for details. Is the Applican 5 Yes ears of Age or More on December 1 of the Year Prior annually adjusted.] ee rev- :for details. Have You Filed for•¶y /er Deductions? If Yes, a Deductions? / 1 Yes ❑ NoI Have You Filed for edu ren in Any Other County? If Yes,What Co ty? t l ❑ Yes ❑ No Ann � • I/We certify under penalty of perjury that the above and foregoing information is true and correct. Ar R ,n � c,. ,,, 9 Sig re of Applica Da onnth,,day,year)Ifl `49? , Address of Ap licant(n 6er nd street,city,state,and ZIP code) O/�c Q Signature of Authorized Representative / Date(month,day,year)' ( Oq Address of Authorized Representative(number and street,city,state,and ZIP code) Sig yrq Count Audi v Date(m nth,da year) DISTRIBUTION: Original—County Auditor;File-Stamped Copy—Taxpayer