Age_Gonyer esorini RetF ,1"a APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR 5k - 1 PROPERTY TAX BENEFITS o State Form 43708(R1(3/9-24) - ME 0 iTh F112 ra. 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. See reverse side for additional instructions and qualifications. Type of Benefit Requested(Please a all that apply) Over 65 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 Properly? ❑ Ye ❑ No Name of Contract Seller Has Applicant Owned or Bought the Property U er corded Contract for at Least One(1)Year before Claiming Deduction? Yes ❑ No Address of Contract Seller(number and street,city,state,and ZIP code) I roperty In Question: i Real Property Mobile Home(IC 6-1.1-7) Taxing DistrictO�� Key umber/Leal-D^s�ril_Q�� `���^ Record Nu ber Page Number • Does Applicant eside 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 ❑ 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 5 ars of Age or More on Decem er 1 of the Year Prior Yes IDNo ' Have You Filed for D ud on in Any Other o nty? If Yes,What Couni ? ❑ Yes No Pit n I/We certify under penalty of perjury t at he above and foregoing information is true and correct. kb / Signa a of Applicant Date(month,day,year) 4/if 1 Address of Applicant(number a street, ,state,an P code) r cva Crl - S n- V1�6 �'9% Signature of Authorized Representative Date(month,day,year) CO(/Nry, Address of Authorized Representative(number and street,city,state,and ZIP code) Cp —1 Signatur of oun Auditor Date )y,(m nth, a year k YU - z — DISTRIBUTION: Original—County Auditor;File-Stamped Copy—Taxpayer