HomeMy WebLinkAboutAge_Cockrum �--5 s & —
APPLICATION FOR SENIOR CITIZENiii YEAR
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RTY Y TAX BENEFITS State Form 43708(R19/ 7-25) (1 ' S\j‘ C)2-1
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'•" - " Prescribed by the Department of Local Government Finance
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. DEC 1 1 2025
Instructions: To be filed in person or by mail with the county auditor of the county where the property is located.
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Filing Date: Form must be completed, signed, and filed with the county
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Type of Benefit Requested (Please c e k all that apply)
Over 65 Credit Over 65 Circuit Breaker Credit
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of Applicant (owner or contr ct b yer) /Telephone Number it Address
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Is Applicant t ole Legal or Equitable Owner? If No, What is Applicants Exact Share or Interest? If Owned with Joint Tenant or Tenant in Common, Indicate with Whom
Yes ❑ No
If Name on eco is Different than Applicant. Indicate Below Do All Joint Tenants or Tenants in C•mm••n Reside on the Property?
I.1 Yes ❑ No
Name of Contract Seller Has Applicant Owned or Bought the `r••- Under Recorded Contract
for at Least One (1)Year before Clarmn credit'?
Yes ❑ No
Address of Contract Seller (number and street. city, state, and ZiP code) Is t e Property in Question:
eaI Property ❑ Mobile Home (IC 6-1.1-7)
Taxing District - Key N ber/Legal Descripton r Record Number Page Number
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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 k 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 Prior to the Year Taxes are First Due& Payable? ei Yes ❑ No
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I/We certify under penalty of perjury that the above and foregoing information is true and correct.
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(XSignature of Applicant Date (month, day, year)
Address of Applicant (nu er and street, city, stat` Z1P code)
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Signature of Authorized Representative Date (month, 4, ar)
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Address of Authorized Representative (number and street, city. state. and ZIP code) 4e-
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Signature of CountyAuditor
C---.)-j Date o h, da , year)
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DISTRIBUTION: Original - County Auditor; File-Stamped Copy - Taxpayer