Age_Blake Reset Form
APPLICATION FOR SENIOR CITIZEN OUNTY TOWNSHIP ' YEAR
4.-: �i. PROPERTY TAX BENEFITS
a .,. j,r) O ?�-- 2�2 5-
t .' /� State Form 43708(R18/9-24)
'°1° 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 instructions and qualifications.
Type of Benefit Requested(Please the k all that apply)
Over 65 Deduction from
Tenant or Tenant in Common,Indicate with Whom
I:l Yes ❑ No
If Name o •.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 Un r 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 he roperty in Question:
Real Property ❑ Mobile Home(IC 6-1.1-7)
Taxing District 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[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 Years of Age or More on December 31 of the Year Prior
Yes El No S-
Have You Filed for D u ion In Any Other County? If Yes,What County?
❑ Yes ►i No
I/We certify under penalty of perjury that t=above and foregoing information is true and correct.
SI re of Applicant Date(month,year)
Add ss of Applicant(number and street,cif ,state,and ZIP code) 1 ��
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Signature of Authorized Represents e ; Date(month,day,year)
Address of Authorized Representative(number and street,city,state,and ZIP code)
Signature of County A ditor FILEDate or h, ,year)
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Jul- 2 2 2025
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DISTRIBUTION: Original—County Auditor,File-St ed Copy—Taxpayer
GIB CG. %r+a)
TY AUDITOR