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=- -" `, APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
/ Y PROPERTY TAX BENEFITS
'`.46., 4/ State Form 43708 (R19 /7-25)
61)66746tid L.4.----
.„...... ,„,
....- -- '. 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 cal ar a n
which the property taxes are first due and payable.
See reverse side for additional instructions and qualifications. DEC
Type of Benefit Requested (Please check all that apply) 2025::?
'Over 65 Credit Over 65 Circuit ker CreditName of Appli nt (owner or act buyer
? If 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?
ZYes ❑ No
Address of Contract Seller (number and street, city, state, and ZIP code) Is the Property in Question:
Real Property ❑ Mobile Home (/C 6-1.1-7)
Taxing istrict Key Number/ Legal Description Record Number Page Number
kiA131961 . Lv - 1''q-g 1 - ./I �d6e, ;2 ) .4(7
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? A
•
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
$
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of Applicant 13 y Date (month. day, year)
-, 7
.y#4.„
r Address,of Applicant umber and street, city, state. a ZIP code)
s-Ci_b --- EZ,44 3-1.- ( /HI ' _7
Signature of Authorized Representative ! Date (month, day, year)
Address of Authorized Representative (number and street, city, state. and ZIP code)
Signet (a of Geunty Auditor f� Date/ ih.
(m day, y r)
L-/' ( "ik,q(L•0_
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DISTRIBUTION: Original - County Auditor: File-Stamped Copy - Taxpayer