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,�` ""' APPLICATION FOR SENIOR CITIZEN
� 4� COUNTY TOWNSHIP YEAR •
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PROPERTY TAX BENEFITS
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State Form 43708 (R19/ 7-25) 6.:it,6 &cii-EX a.0
'•.• Prescribed by the Department of Local Government Finance
Information contained in this document is CONFIDENTIAL pursuant to IC - .1- - .
Instructions: To be filed in person or by mail with the county auditor of the county where_the Rroperty is located.
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Filing Date: Form must be completed, signed. and filed with the county auditor or postmarked by Ja A ary 15 of the calendar year in
which the property taxes are first due and payable- is. .
See reverse side for additional instructions and qualifications. `722 - t a. ��
AUDITOR
Type of Benefit Requested (Please check all that apply)
t4Over 65 Credit Over 65 Circuit Breaker Credit
N*leof Applicant (owner or contract uyer)
ned with Joi Tenant or want ini mon, Indicate with Whom
7
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:
JO Real Property ❑ Mobile Home(iC 6-1.1-7)
Tax- District 'RISC Key Number! Legal Description Record Number Page Number
7
eZ-T-E-R___ ( 6 ‘ a-) - (-)&---- tD - 3600 , g7SDD , --U4 �
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 b(J Yes ❑ No
preceding calendar year) and does Applicant qualify for the homestead standard deduction in the current year?
Is the Applicant 65 Years of Age or More on December 31 of the Year Pnor to the Year Taxes are First Due 13 Payable? ]Yes ❑ No
$
I!We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of licant Date (month, day, year)
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Address of nun! r ands et, c , ate, a e)
Signature of Authorized Representative Date (month, day, year)
Address of Authorized Representative (number and street, city, state. and ZiP code)
Sign t e of county Auditor Date (month, ay, year)
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.44.7
VI(CU1 6,4k<9 i ej4 11)/ 0.26, (i3
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DISTRIBUTION: Original — County Auditor: File-Stamped Copy — Taxpayer