Age_Meyer -„~` `T"'U. APPLICATION FOR SENIOR CITIZEN
C • YEAR
, - '1 , PROPERTY TAX BENEFITS
/r State Form 43708 (R19 17 25) `�� rr� 7)025 --'
' ! - Prescribed by the Department of Local Government Finance
C9 V
DEC o 9 2025
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 loc 1.
Filing Date: Form must be completed, signed, and filed with the county auditor or postmarked by Januaryd M tia`dr
which the property taxes are first due and payable. UN AUDITOR
See reverse side for additional instructions and qualifications.
Type of Benefit Requested (Please check all that apply)
Over 65 Credit INvver 65 Circuit Breaker Credit
e of Ap�lica�t (owner or contract buyer)
with Joint Tenant or Tenant in Common, Indicate with Whom
❑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 Credit?
❑ Yes ❑ No
Address of Contract Seller (number and street, city, state, and ZIP code) Is the Property in Question:
iNtReal Property ❑ Mobile Home (IC 6-1.1-7)
Tax District Key Number/ Legal Description Record Number Page Number
a - 21-.3� - ,?1�3 - 7 D 3Y �f� ool
Did Applicant qualify for the ho estead 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 ElYes ❑ No
preceding calendar year) and does Applicant qualify for the homestead standard deduction in the current year?
Is the Applicant 65 Years of Age or More on December 31 of the Year Prior to the Year Taxes are First Due& Payable? 1R Yes ❑ No
Source of Income Amount of Income
Adjusted Gross Income (AGi) of applicant, applicant and spouse, or applicant — ��
and joint tenants or tenants in common, as applicable (For Over 65 Credit, AG! /
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signatur o Applicant Date (month, day, year)
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Address of Applicant (number and street, city, state, n Zl code)
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Signature of Authorized Representative / Date (month, day, year)
Address of Authorized Representative (number and street. city, state, and ZIP code)
Signature of County Au itor Date (month, day, year
/il 9 AA 5
DISTRIBUTION: Original - County Auditor; File-Stamped Copy - Taxpayer
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