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Age_Mullis Reset$Foilb e ' 44. APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP NM aye --litPROPERTY TAX BENEFITS (--1,0, •yam ' State Form 43708(R18/9-24) r /tlllI a5"'• Prescribed by the Department of Local Government Finance k - ,/ Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. �N�6 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. Pitt Type of Benefit Requested(Please check all that apply) Over 65 Deduction from Assessed Valuation X.Over 65 Circuit Brea.; s edit _15){gn9c r _,. Name f Applicant(owner or contract buyer) Owned with Jrigte or Tenant in Common,In.icate with Whom Yes ❑ No f SON co CO dp n If Name on Record is Different than Applicant,Indicate Below Do All Joint Tenants or Tenants Of ' n the Property? 6,yes,T0R'. ❑ 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,city,state,and ZIP code) Is the Property in Question: 3.1 Real Property ❑ Mobile Home(IC 6-1.1-7) Taxing District Key Number I Legal Description Record Number Page Number da° 1T�� , R6- �- tot Fa�'r Dg6 °toDoes 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, Yes ❑ No and$239,999(all Indiana real property]for the Over 65 Ci cult 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 _ XYes El No Have You Filed for Deduction in Any Other County? If Yes,What ounty? ❑ Yes Klo I/We certify under penalty of perjury that the above and foregoing information is true and/ correct. Signatur plicant IIL,A/ Date(month,day,year) 5� i 14- x 9--a5—a 0 25 Add ss of Appli n (nu er nd street,city,sta an !P code) o 1 /Aico )F , a AI 7/W g' Signature of Authorized Representative 'Date(month,clay,year) Address of Authorized Representativ (number and street,city,state,and ZIP code) Signatu o Coaty Auditor ��I Dateboirif!,/etA©�J fil DISTRIBUTION: Original—County Auditor;File-Stamped Copy—Taxpayer