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"'!'4 APPLICATION FOR SENIOR CITIZEN CoFfIFTE- - YEAR
*11' ' PROPERTY TAX BENEFITS
State Form 43708 (R19 /7-25)
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 locat d.
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Filing Date: Form must be completed, signed, and filed with the county auditor or postmarked by January 1
which the property taxes are first due and payable. efY AUDITOR
See reverse side for additional instructions and qualifications.
Type of Benefit Requested (Please check all that apply)
cgi Over 65 Credit IZ Over 65 Circuit Breaker Credit
Name of Appli t (owner or contract buye,)
Owned with Joint Tenant or Tenant in Common, Indicate with Whom
Yes ❑ 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?
IIVYes ❑ No
Address of Contract Seller (number and street. city, state. and ZiP code) Is the P -.perty in Question.
LI Real Property El Mobile Home (IC 6-1.1-7)
Taxing District r Key Number/ Legal Description Record Number Page Number
CVO _162 _D7 —103rCOO. .50g U ,z -)—
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?
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I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature Applicant _f.--- Date (month, day, year)
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Address of Applicant (number an 'street, city, state, and ZIP 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 Auditor Date (month. day, year)
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DISTRIBUTION: Original - County Auditor: File-Stamped Copy - Taxpayer