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Age_Knapp Reset Form 0``�''% APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR a PROPERTY TAX BENEFITS 0r0c.� State Form 43708(R18/9-24) 3;./i :gc)/3 //f"�Y 1(( 1=� a-5- mi. Prescribed by the Department of Local Government Finance ((/�-mot/ (iGf v Y L.Ifu 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 o/th c le ar y r in which the property taxes are first due and payable. -+ See reverse side for additional instructions and Joint Tenant or Tenant in n�(ddwith Whom EYes ❑ No If Name on Record is Different than Applicant,Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property? XYes ❑ No Name of Contract Seller Has Applicant Owned or Bought the Property Under Recorded Contracttr} for at Least One(1)Year before Claiming Deduction? ❑ Yes X�No Address of Contract Seller(number and street,city,state,and ZIP code) Is the Property in Question: o A Real Property El Mobile Home(IC 6-1.1-7) Toxin t 1L/— Key Number/Legal Description Record Number Page Number o 6,,-iO - V- r o-alll ag5= o©i 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 fall • Indiana real property]for the Over 65 Circuit Breaker Credit initially applied for after December 31,2019 and before January 1,2023, NAYes ❑ 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 �/� Ni‘Yes ❑ No �`I/(/t�' V G�� Have You Filed for Deduction in Any Other County? If Yes,What County? ❑ Yes k No IIWe certify under penalty of perjury that the above and foregoing information is true and correct. ',Signature of Applicant KC)/AA:'%- Date(month,day,year) qeAff Ad s of t/Appint(numb et, st e,and IP code)Sav /Z 4�t eA Signature of Authorized Representative /rlJt / Date(month,day,year) Address of Authorized Representative(number and street,city,state,and ZIP code) Signatu a County editor CYG'V ��.�(%4 1 Date(m ar) ,..#, ,/a)a°a.oC >. DISTRIBUTION: Original—County Auditor;File-Stamped Copy—Taxpayer