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,_tQ""r• APPLICATION FOR SENIOR CiTIZEN COUNTY TOWNSHIP T YEAR
tI t PROPERTY TAX BENEFITS
,.....,„ .J State Forrn 43708(R19 l 7-25) 6,6, ,,,,i
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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.
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 th ale a TE1
which the property taxes are first due and payable.
See reverse side for additional instructions and qualifications. DEC 1 O 2025
Type of Benefit Requested (Please check all that apply)rZ( C f
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Over 65 Credit "inOver 65 Circ it reaker Credit
Name of Applicant(owner or contract buyer)
if Owned with Joint Tenant or Tenant in Common, Indicate with Whom
ZI 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?
71,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)
TaxjagOistylitt Key Number/ Legal Description 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 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? Yes ❑ No
$
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of Applicant Date (month. day, year)
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Address of Applicant (number nd street, city, s . and ZiP e)
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Signature of Authorized Representative Date (month, day, year)
Address of Authorized Representative (number and street. city, state. and ZIP code)
Sign ur of CoAuditor T Date (month, d y, year)
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DISTRIBUTION: Original — County Auditor: File-Stamped Copy - Taxpayer11