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Age_Dersch Reset Form et' APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR 4-:- J,R PROPERTY TAX BENEFITS /� C ,o ' ! State Form 43708(RIB/9-24) 5c ► 1 O cr /Z�°1e Prescribed by the Department of Local Government Finance `J 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: Fomi 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. `' Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit Name of Applicant(owner or contrac bu r Owned with Joint Tenant or Tenant in Common,Indicate with Whom ❑ Yes ❑ No If Name on Record Is Different than Applicant,Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property? ❑ 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 ❑ No Address of Contract Seller(number and street,city,state,and ZIP code) Is t operty in Question: eaI Property ❑ Mobile Home(IC 6-1.1-7) Taxing Dlstr Key Number/Legal Description Record Number Page Number 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, Yes ❑ No and$239,999 fall Indiana real property)for the Over 65 Circuit Breaker Credit Initially applied for after December 31,2022.)See reverse for details. Is the Appli t 65 ears of Age or More on December 31 of the Year Prior $ annually adjusted.)See reverse for details. ` ).. Have You Filed for An Other Deductions? If Yes,Wet De�tions? Yes ❑ No lSZ7X- Have You Filed for due'on in Any Other oun If Yes,ltt/Aat County'? ❑ Yes No ✓ '4,6 U� , . I/We certify under penalty of perjury at th above and foregoing info ation is true and cord 611 i ature of Ap 'cant Da .a ,year) ©� eat*. Op Address o Applicant(number and street,city,state,an code) Z43-z s st 5� an8_G-1j- � \- '49-66 0 �' .6,4. Signature of Authorized Representative 1 Date(month,day,year) • Address of Authorized Representative(number and street,city,state,and ZIP code) Signature of ty Au ' Date(month y,7r) a I"). ,---i, 2 . . DISTRIBUTION: Original—County Auditor;File-Stamped Copy—Taxpayer