Age_Burkhardt `T- 4 APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
\` PROPERTY TAX BENEFITS
j/ J State Form 43708(R19/7-25) lJ^�\t 0 f�V1 2
,ele 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: 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.
Over 65 Credit v �J Over 65 Circuit Breaker Credit
Name of Applicant(owner or contra yer) Telephone Number ail Address
U\c Ck �1 uyk V�1t'/1 ( ) „otll'
Is Applicant he le Legal or Equitable Ownee r'?t If No,What is Applicants Exact Share or Interest? If Owned with Joint Tenant or Tenant in Common,Indicate with Whom
Yes ElNo
If Name on R 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 orpought the Property Under Recorded Contract
for at Least One(1)Year before Claimin . •
/:I Yes ❑No
Address of Contract Seller(number and street,city,state,and ZIP code) Is t e P perty in Question:
Real Property ❑Mobile Home(iC 6-1.1-7)
Taxing District Key Number/Legal Description Record Number Page Number
n 04- • 24 11-1 v 104--o00.21° -00-- .
Did Applicant qualify for the homestead standard deduction in the preceding year(or was applicant married at the time of death to
a deceased spouse who qualified for a homestead standard deduction for the individual's homestead property in the immediately Yes ❑No
preceding calendar year)and does Applicant qualify for the homestead standard deduction in the current year?
Is the Applicant 85 Years of Age or More on December 31 of the Year Prior to the Year Taxes are First Due&Payable? Yes ❑No
)(Signature ofA Applicant Date(mt3fAfr,da -I
9 PP
k)kcoc,=,.. $6.4......
Address of Applicant(number and street,city,state,and ZiP code) AUG 12 2025
530 ry V\c-O son S`- Oi tGncl G - -(.\ '-
Signature of Authorized Representative J Date( onth,,day,year)
Address of Authorized Representative(number and street,city,state,and ZIP code) CIDSON COUNft Y AUDITOR
Signature of County Auditor Date 7lliqayt7r)flekn J) (N2 ,�1
DISTRIBUTION: Original-County Auditor;File-Stamped Copy-Taxpayer