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APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
PROPERTYTAX BENEFITS
State Form 4 3 p V708(R19 17-25) , ) � 00
6 r2
Prescribed bythe Department of Local Government Finance �V C
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 calendar year in
which the property taxes are first due and payable.
See reverse side for additional instructions and qualifications.
Type of Benefit Requested (Please check all that apply)
p Over 65 Credit ❑✓ Over 65 Circuit Breaker Credit
Name of Applicant (owner or contract buyer)
Owned with Joint Tenant or Tenant in Common, Indicate with Whom
QYes ❑ No
If Name on Record is Different than Applicant, Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property?
p 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?
nYes ❑ 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)
Taxing District Key Number/ Legal Description Record Number Page Number
Columbia Township 26- 13-12-200-000.207-006
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 ID Yes ❑ No
preceding calendar year)and does Applicant qualify for the homestead standard deduction in the current year?
$
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature 4f Ap scant Date (month. day year)
I• / 12/17/2025 0
Address of Applicant (number an• street, city, state. a•• ZIP code) I-
11262 E . Base Road, Oakland City, IN 47660
F.131
Signature of Authorized Representative Date (month, day, year) N -
Address of Authorized Representative (number and street, city state, and ZIP code) U O
�•� w • z
t� o
Signature of County Auditor Date (month, day. year) U)
tfn 12/17/2025 co�
DISTRIBUTION: Onginal - County Auditor; File-Stamped Copy - Taxpayer