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Age_Parish ( Reset Form ER" .3 APPLICATION FOR SENIOR CITIZEN OUNTY TOWNSHIP YEAR a •:.•; };; PROPERTY TAX BENEFITS �/� . State Form 43708(R18/9-24) d O \ �'ill '‹A �(2/3--- 'iv.... < v1 '•'• 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. Type of Benefit Requested(Please cec allthat apply) Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit Nam plicant(owner Mr t yer) Telephone Number m it Address 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 U .er Re = .ed Contract for al Least One(1)Year before Claiming Deduction? Wi Yes ❑ No Address of Contract Seller(number and street,city,state,and ZIP code) Is the Property in Question: KRea t Property ElMobile Home(IC 6-1.1-7Taxing District Key Number I Legal Description Record Number Page Number 01 • 26-o,.444 WI— 0uO .64--3 - oie Does Applicant Reside on Property? Assessed value of the p7bperty 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 Indiana real property]for the Over 65 Circuit Breaker Credit initially applied for after December 31,2019 and before January 1,2023, X.Yes ❑ 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.detals. Is the Applicant 65 Years of Age or More on December 1 of the Year Prior TOTAL $ annually adjusted.]See reverse for details. Have You Filed for Any th Deductions? , If Ye , t gpduclions? Yes El No J /y' Have You Filed for D u ' n in Any Other County'? If Yes,What County? J El Yes ❑ No T I/We certify under penalty of perjury that the above and foregoing information is true and correct. �q, Signs re of Applicantpauzil,„, th,day,year) © '1, (24.f 40, Ad Applicant(number and street,cly,state,and ZIP code) Nc ,z, (76,..+.01.2\ •••••7 4.i Signature of Authorized Representative Date(month,day,y /l. 0,9 Address of Authorized Representative(number and street,city, ,and ZIP code) Signature of unty Audit 0 Date(month,da ,y ar) �, 1 >>�,�3 LA 2 DISTRIBUTION: Original—County Auditor;File-Stamped Copy—Taxpayer