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Age_Fitch ROA Form (R4� e ; s:,q. APPLICATION COUNTY TOWNSHIP YEAR si, - PROPERTY TAX BENEFITS ,:,,,,... ;�� State Form 43708(R18/9-24) dj '�'" 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 c n ar y which the property taxes are first due and payable. 1 ' See reverse side for additional instructions and qualifications. D Type of Benefit Requested(Please checkchck all that apply) APR ' +fir -clover 65 Deduction from Assessed Valuation 5Qver 65 Circuit Breaker Credit O 2025 l �� N e of Applica ner or contract yer) Owned with Joint Tenan Vr ettgernic40.414ftivatrith Whom Yes ❑ No AUpfT�R If Name on Record is Different than Applicant,Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property? EYes ❑ 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 ❑ No Address of Contract Seller number and street,ciitty,rstate,and ZIP c ©J �'7 ir� Is the Property in Question: ('O ' u ( n-i g rik Sr �kn c6 v,' l yn$eal Property ❑ Mobile Home(IC 6-1.1-7) Taxing District Key Number/Legal Description Record Number Page Number de3 Flo--/0 .-0q- 308- ooag. 3-0 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[all Indiana real property]for the Over 65 Circuit Breaker Credit initially applied for after December 31,2019 and before January 1,2023, XYes ❑ 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 Other Deductions? If Yes,Wha ed�fcuctioo-nss? EElF►Yes No �(�SI Have You Filed for Deduction in Any Other County? If Yes,What County? ❑ Yes KNo I/We certify under penalty of perjury that the above and foregoing information is true and correct. Signature of ApplicantN . Date(mo ,year) Address of Applicant(number and street,city,state,and ZIP code) Signature of Authorized Representative Date(month,day,year) Address of Authorized Representative(number and street,city,state,and ZIP code) Signs re f Count Auditor r Date(month„d year) / yi\DISTRIBUTION: Original-County Auditor,File-Stamped Copy-Taxpayer