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~` ""' APPLICATION FOR SENIOR CITIZEN
" COUNTY TOWNSHIP YEAR
- -\-1.itiss, PROPERTY TAX BENEFITS ' •
State Form 43708 (R191 7-25) ()kW i< k ,..4.C.--
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.
Ftlrng Date: Form must be completed, signed, and filed with the county auditor or postmarked by January 15 of the cafe a y r i
which the property taxes are first due and payable. ED
See reverse side for additional instructions and qualifications.
Type of Benefit Requested (Please check all that apply) Dec 2
,Over 65 Credit Over 65 Circu Beaker Credit 2025
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Name of Applicant (owner or contract buyer)
If Owned with Joint Tenant or Tena ern a with Whom
\ViYes ❑No oirOp
If Name on Record is Different than Applicant. Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property?
Byes ❑ No
Name of Contract Seller Has Applicant Owned or Bought the Property Under Recorded Contract
for at Least One (1)Year before Claiming Credit?
c- s ❑ No
Address of Contract Seller (number and street, city, state, and ZIP code) Is the Property in Question:
teal Property ❑ Mobile Home(IC 6-1.1-7)
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District Key Number I Legal Description Record Number Page Number
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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?
Is the Applicant 65 Years of Age or More on December 31 of the Year Pnor to the Year Taxes are First Due 8 Payable? 'Yes ❑ No
$
INVe certify under penalty of perjury that the above and foregoing information is true and correct.
Sig tul of plicant n - Date (month, day. year)
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Addres of Applicant ( r and street, city, state, and ZIP de)
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Signature of Authonzed Representative t Date (month, day. year)
Address of Authorized Representative (number and street, city, state, and ZIP code)
Sign ur of County Auditor7 Date (month, y, year
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DISTRIBUTION: Original - County Auditor: File-Stamped Copy - Taxpayer