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Age_Parks Reset Form 7 .1 APPLICATION FOR SENIOR CITIZEN ` 4 y�4 COUNTY TOWNSHIP YEAR 4 - 11 PROPERTY TAX BENEFITS n\sche-\ ff�� �^(� ..,_ jb :,j State Form 43708(R18/9-24) Of�oie role 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. Ii Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit Nalmen ppplillcant((oowneror c. ct+ er) Telephone Number E ail Address ro Is Applicant th Sole Legal or Equitable Owner? If No,What is His/Her Exact Share or Interest? If Owned with Joint Tenant or Tenant in Common,Indicate with Whom Yes ❑ No If Name on eco d 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 corded 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 Property in Question: Real Property ❑ Mobile Home(/C 6-1.1-7) Taxing District Key Number/Legal Description Record Number Page Number 001 - A- 13-13-- 02-oo0. 31-2.- ° - 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 65 Years of Age or More on December 31 of the Year Prior $ annually adjusted.]See reverse for details. Have You Filed for Any t Deductions? If Yes,Wh edSons? Yes 0 No tt{ '''';(1 Have You Filed for De lion in Any Other C nty? If Yes,Wh County? is'd42, � ❑ S O r/ /We certify under penalty of perjury th ove and foregoing information is true and correct. '9�/G, Signature ppli n Date( i�ay1,year) Of' � ��S ddress Applicant(number an *tree city, tate,and ZIP code) ��(ic ill Signature of Authorized Representative / Date(month,day,year) 1(4 Address of Authorized Representative(number and street,city,state,and ZIP code) ©� Signature of Coun uditor Date(moot da ar) \NU. �t ) s ) Er- _ ., DISTRIBUTION: Original—County Auditor;File-Stamped Copy—Taxpayer