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.„M` s"''� APPLICATION FOR SENIOR CITIZEN FILE? P YEAR
=! 111 PROPERTY TAX BENEFITS
State Form 43708(R19 / 7-25) ,�
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eie ' Prescribed by the Department of Local Government Finance 5 20 5
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. DECU[l,
Instructions: To be filed in person or by mail with the county auditor of the county where the property is 1 d. �
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Filing Date: Form must be completed. signed, and filed with the county auditor or postmarked by Januat9taitedibeVeriarosimotToR
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)
r_AOver 65 edit rdt Over 65 Circuit Breaker Credit
~tfine of Applicant (owner or ntract bu er)
with Joint Tenant or Tenant in Common, Indicate with Whom
Ep Yes ❑ No
If Name on Record is Different than Applicant, Indicate Below Do All Joint Tenants or Tenants in C moti Reside on the Property?
Yes ❑ No
Name of Contract Seller Has Applicant Owned or Bought the Prope Under Recorded Contract
for at Least One(1)Year before Claimigg edit?
Yes ❑ No
Address of Contract Seller (number and street, city, state, and ZIP code) Is the roperty in Question:
1 Real Property ❑ Mobile Home (iC 6-1.1-7)
Taxing District Key Number/ Legal Description Record Number Page Number
jiAite-A/L(2 -66-e. e41 '177tr 2of - 000. oeq _ a A. t)__
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?
$
INVe 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 ApiSicant (number and street. city, state, and ZIP code)
Signature of Authorized Representative Date (month, day, year)
Address of Authorized Representative (number and street, city, state, and ZIP code)
Signature of County Au 'tor Date (month, day, year)
(A)e31--- --/P -0 4 7,17c.. IA .- 5 - A5
DISTRIBUTION: Original - County Auditor; File-Stamped Copy - Taxpayer