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Age_Davis 13:PAOLF,9n.ti,
"TN, APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
PROPERTY TAX BENEFITS ,
.v..:.';..- State Form 43708(R18/9-24) 1 \
ex)L5----
\..)on Co,
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 instructiorInab qualifications.
Type of Benefit Requested(Please c.: k all that ap ly) a,\AA
- FA Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Nams pplicant(owne . ontr. lb ,.1-)
Joint Tenant or Tenant in Common,Indicate with Whom
kvd Yes 0 No
If Name on-•c•rd is Different than Applicaicate Below Do All Joint Tenants or Tenants in Common Reside on the Property?
0 Yes 0 No
Name of Contract Seller e Has Applicant Owned or Bought the Property Und R corded Contract for at Least
One(1)Year before Claiming Deduction? es 0 No
Address of Contract Seller(number and street,city,state,and ZIP code) Is the P operty in Question:
Real Property 0 Mobile Home(IC 6-1.1-7)
Taxing Dist 12
mber/Legal Description Record Number Page Number
Property?Does Applicant Reside
Assessed value of the property as of current year assessment date(May not excee .9240,000 for Over 65 Deduction or
on
$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 0 No and$239,999 fall Indiana
annually adjusted.]See reverse for details.
Have You Filed for Any Ot Deductions? If ,ylhat Ic:luctions?
Yes El No
Have You Filed for De lion in Any Other C unt . If Yes, hat County?
0 Yes No
I/We certify under penalty of perjury t t e above and foregoing information is true and correct. F •
ii,
Signature plicant 6airrrz j.) ,
Date(month,day,AyeParR) 28 2025
Addres 9f4pplicant(n bar and street,cistate,
and T..5're)
-
Signature of Authorized Representative ) Date(mo ay,year)
a pk-
GiesoN - -wind)
Address of Authorized Representative(number and scree city,state,and ZIP code) cot,NTY AUDITOR
SignatureOunt§Zditor Date(Lol ,clayeAsar)
2/ ---
1 C13 ‘ C\
DISTRIBUTION: Original—County Auditor,File-Stamped Copy—Taxpayer