Age_Rottet 1
APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
PROPERTY TAX BENEFITS
State Form 43708(R18/9-24) tbstYl\I 6A-Kuhol A-
.41. 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.p
Filing Date: Form must be completed,signed,and filed with the county auditor or postmarked by January 15 of the ar ye *
which the property taxes are first due and payable.
See reverse side for additional instructions and qualifications. APR 1 0 2025
Type of Benefit Requested(Please check all that apply)
fflOver 65 Deduction from Assessed Valuation E'Over 65 Circer Credit
17.4
me off Applicant(o ner or contract buyer Zoe
If Owned with Joint Tenant or Tenant in Cornnmite9late with Whom
XYes El No ..
If Name on Record is Different than Applicant,Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property?
• Yes El No
Name of Contract Seller Has Applicant Owned or Bought the Property Under Recorded Contract for at Least
One(1)Year before Claiming Deduction? %Yes E No
Address of Contract Seller(number and street,city,state,and ZIP code) Is the Property in Question:
:SCReal Property r_i Mobile Home(IC 6-1.1-7)
Taxing District Key Number/Legal Description Record Number Page Number
00 1.7
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
S199,999(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,
XYes El No and$239,999 fall 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, a eductions?
EYes El No kW-51- 74-b
Have You Filed for Deduction in Any Other County? If Yes,What County?
0 Yes El No .
I/We certify under penalty of perjury that the above and foregoing information is true anctcor ct.
ii of Applic t p/(.1.._ ate(month,14ay year)
ig
oil
Address of Applip t er and street city,sj,,,and ZIP tfi a
4io ,A/ ...),4-e_K 6 eAt,y7- boo (Tv,/ ehip6o
Signature of Authorized Representative Date(month,day,year)
Address of Authorized Representative(number and street,city,state,and ZIP code)
x
Signat re f Coun AtKeitto.r.t jVa:140,./144)(1,34 Date(month,dwWiear)
DISTRIBUTION: Original—County Auditor;File-Stamped Copy—Taxpayer