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f "'� APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
(4 1 PROPERTY TAX BENEFITS
1.46.K.,_.
/) State Form 43708 (R19 /7-25)
' !r Prescribed by the Department of Local Government Finance .61)/,7 ()&( 0 t ,as e
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 i ted.
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 payab'^ DEC 10 2025 i•
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See reverse side for additional instructions and qualifications
Type of Benefit Requested (Please check all that apply) (thGG .0 C.G. .1/(atte tl)
14 Over 65 Credit id Ovee6BSerhli at `CALIDITOR
me of Applicant er r contract buyer)
oYes ❑ No
tf Name on Record is Different than Applicant. Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property?
❑ YesNo
Name of Contract Seller Has Applicant Owned or Bought the Property Under Recorded Contract
for at Least One(1)Year before Claimi , C edit?
_ fj2 Yes ❑ No
Address of Contract Seller (number and street. city. state. and ZIP code.) Is the Property in Question:
Real Property ❑ Mobile Home (IC 6-1.1-7)
T ingi,District Key Number I L gal Description Record Number Page Number
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Did Applicant qualify fo e 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 El 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? Yes ❑ No
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I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signatur of Applicant Date (month, day, year)
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Ad of Applicant (nu r and styeS.:tate, a iP co i?)
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1 i a) V dk • di 4 '76
Signature of Authorized Representative j Date (month, day, year)
Address of Authorized Representative (number and street, city, state. and ZIP code)
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Sig lure of-Co my Audit r iC- ., Date (month, day, year
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DISTRIBUTION: Original — County Auditor; File-Stamped Copy — Taxpayer