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�,„` 'T'T•o. APPLICATION FOR SENIOR CITIZEN OUNTY TOWNSHIP ' YEAR
_' 4TPROPERTY TAX BENEFITS j
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,, State Form 43708 (R19 17-25) . Qr 70 2_ ? -
'•.• 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
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Type of Benefit Requested (Please e all that apply)
,;.4
Over 65 Credit Over 65 Circuit Breaker Credit
Name of Applicant (owner or contr ct b er) Telephone Number E ail Address
ic1cO S & Ls . ( )
Is Applic t the Sole Legal or Equitable Owner? If No, What is Applicant's Exact Share or Interest? If Owned with Joint Tenant or Tenant in Common. Indicate with Whom
No Yes ❑ No
If Name on -eco . 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 P Under Recorded Contract
for at Least One(1)Year before Claiming Credit?
j Eyes ❑ No
Address of Contract Seller (number and street, city, state, and ZIP code) Is the Property in Question.
XRealProperty ❑ Mobile Home (IC 6-1 1-7)
Taxing District Key Number 1 Legal Description Record Number Page Number
26 - I L\-f -- 300 --ooO & 1 --oo(),
CIDC •
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?
$ j
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of Applicant T Date (month day, ye r)
dfeaalf
Address of A plicant (number and street, city, state. and ZiP code)
T-i 2 S 12 - -. E 01 ) 0,n Syr D 'r) -- i 1 C 4 0 . -
Signature of Authorized Representative 1 Date (month, day, year)
Address of Authorized Representative (number and street. city, state, and ZIP code)
Sig ture of ount itor MEP Date (month,7Y. Year)
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1 )----
DEC 2 6 2025
DISTRIBUTION: Original - County Auditor: File-Stamped Copy - Taxpayer
GiBCOUNTY.�. U
AUDITOR