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~` APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP j YEAR
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PROPERTY TAX BENEFITS OG
lcifrState Form 43708 (R19 i 7-25) 0A-_) ‘ a 2
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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
.
fType of Benefit Requested (Please chec iI that apply)
Over 65 Credit Over 65 Circuit Breaker Credit
N oca.3
e of Applicant owner or contra t uyer) Telephone Number ma Address
Is Applicant t' - So)ye Legal r Equ le Owner's If No, What is Applicants Exact are or Interest? If Owned with Joint Tenant or Tenant in Common. Indicate with Whom
a Yes ❑No
If Name on Reco • is Different than Applicant, Indicate Bel Do All Joint Tenants or Tenants in Co • Reside on the Property?
Yes ❑ No
Name of Contract Seller Has Applicant Owned or Bought the P•••- . Under Recorded Contract
2025
DEC 3 0 [ LJ for at Least One(1)Year before Claiming r dit?
Yes No
Address of Contract Seller (number and street, city, state, and ZIP code) ;; Is e roperty in Question.
�. x�%&"� Real Property ❑ Mobile Home (iC 6-1.1-7)
Taxin Di ict Key NumbTel AUDiTOR Record Number Page Number
----CCDVA2. 2C 3-- 2 — LC - coo Lco - iCel 6
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 I! Yes ❑ No
preceding calendar year) and does Applicant qualify for the homestead standard deduction in the current year?
I
$
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of Applicant Date (mo h, day, ear)
Address of Arica umber a sire 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)
Sign lure of unty A for, Date (month 941,y, ye )
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DISTRIBUTION: Original - County Auditor: File-Stamped Copy - Taxpayer