Age_Roberts Reset Form
of rm-'°a APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
-- PROPERTY TAX BENEFITS //�/�yQ pA\ I }/ 0a j ,.[n/
.• • at ry State Form 43708(R18/9-24) fileti
o\ r+
'a. 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. F See reverse side for additional instructions and qualifications. 'LED
Type of Benefit Requested Please check all that apply)
YP q ( PPYI
fr ver 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Cr APR
me of Applicant(ow r or contract buyer) Email Address 2 2 2025
Is Applicant the Sole Legal or Equitable Owner? If No,What is His/Her Exact Share or Interest? If Owned with Joint Tena o a tin Common,Indicate wi om
5 Yes ❑ No G(BSON r, �T �•
r�o)
If Na on Record is Different Ih Applicant,Indicate /a Do All Joint Tenants or Tenants in Commo�R6si4 49 CJf� perty?
/ � �j iM 11-11 I UGC�j7- [Yes ❑ 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 El No
Address of Contract Seller(number and street,city,state,and ZIP code) Is the Property in Question: ffff
YI‘Feal Property El Mobile Home(IC 6-1.1-7)
Taxing District Key Number/Legal Description Record Number Page Number
6A/ rl— 302 -4oO-' 5, /778=0-2-1
Does Applicant Reside on Properly? 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 tall
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. ,
,/ �
'Yes ❑ No /"I-E��
Have You Filed for Deduction in Any Other County? If Yes,What County?
❑ Yes )g No
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature Applicant Date(mon(h, ay,year)
as a6 C—
Ad.lizrez. ofirgicac.clnumpersfre*f,cit tale s odg/u /id / _�4s
Signature of Authorized Representative Date(month,day,year)
Address of Authorized Representative(number and street,city,state,and ZIP code)
Signa r of Co ty Auditor Date(month, a ,year)
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DISTRIBUTION: Original—County Auditor;File Stamped Copy Taxpayer