Age_Wilzbacher = -"" 4'' APPLICATION FOR SENIOR CITIZEN
�:' . COUNTY TOWNSHIP YEAR
• '+' PROPERTY TAX BENEFITS
.. State Form 43708 (R19 /7-25) q3 z 5 ---
!,..- 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.
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Type of eneflteequested (Please h k all that apply)
VV 11 Over 65 Credit Over 65 Circuit Breaker Credit
\\-� Name of Applicant (owner or contr ct r}
with Joint Tenant or Tenant in Common, Indicate with Whom
Yes ❑ No t
If Name on c d is Different than Applicant, Indicate Below Do All Joint Tenants or Tenants in Co m n Reside on the Property?
_ Yes ❑ No
Name of Contract eller Has Applicant Owned or Bought the P ope 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 P perty in Question:
Real Property Mobile Home (IC 6-1.1-7)
Taxing District - — Key Number/ Le al Description Record Number Page Number
�,.o>'1 0 Z11 26— (- �oo•�De_ . Ili 4-02H
�
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 65 Years of Age or More on December 31 of the Year Pnor to the Year Taxes are First Due & Payable? es ❑ No
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I/We certify under penalty of perjury that the above and foregoing information is true and correc
ignature of Applicant a (m ar)
ss of plica9tkrJyL
um and st e t. city, e. and ZIP code) 'L02�
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Signature of Authorized Illt epresentative Date (month. day, y ar;r)'/'""
a R„p1ZQR
Address of Authorized Representative (number and street, city, state, and ZIP code)
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G1aSQt�1 C
iSi nature of County Auditor Date (mont , day, ear)
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DISTRIBUTION: Original — County Auditor: File-Stamped Copy — Taxpayer