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s„.` "A''a APPLICATION FOR SENIOR CITIZEN COUNTY FILEp
TOW YEAR
;a ekt PROPERTY TAX BENEFITS
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State Form 43708 (R19 /7-25) 2 3 nazi_ ?�
,•.• Prescnbed by the Department of Local Government Finance
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9.
14-:1241)
Instructions: To be filed in person or by mail with the county auditor of the county where the property is loc �SON COUNTY AUDITOR
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)
El Over 65 Credit Over 65 Circuit Breaker Credit
N e of Appli nt (owneror contrpct b er
Owned with Joint Tenant or Tenant in Common, Indicate with Whom
Yes ❑ No _
If Name on Record is Different than Applicant, Indicate Below Do All Joint Tenants or Tenants in omm Reside on the Property?
Yes ❑ No
'
Name of Contract Seller Has Applicant Owned or Bought the Grope Under Recorded Contract
for at Least One(1)Year before Claim g- [edit?
YesTo ❑ No
Address of Contract Seller (number and street, city, state, and ZIP code) Is the Property in Question: f
eat Property ❑ Mobile Home (IC 6-1.1-7)
Taxing Distnct . 1 Key Number / Legal Description Record Number Page Number
0.60t_e,y‘_,,y,z,t,e,1<_, '1.6, I 7 I el% -07 ezei- COO , (.134 - a .1._ ;—
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 D 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.
)(Signe of Applicant Date (month, day, year)
o p icant umb a s rest, city, state, and ZIP code)
01 9 H L-1(.1/1/A717/57-4-: //2'C/.(/".-5/-
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Signature of Auth nze res tative Date (month, day, year)
Address of Authorized Representative (number and street, city, state, and ZIP code)
Signature of County Au for Date (month. day. year)
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C.C:4____)?
DISTRIBUTION: Original - County Auditor: File-Stamped Copy - Taxpayer