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,„, `'•'•4. APPLICATION FOR SENIOR CITIZEN 1 COUNTY TOWNSHIP YEAR
` : PROPERTY TAX BENEFITS
. State Form 43708 (R19 7-25) S°V) OzLr-)- 2'IS1• 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 county auditor or postmarked by January 15 of the calendar year in
which the properly taxes are First due and payable
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See reverse side for additional instructions and qualifications
Type of Benefit Requested (Please chec all that apply)
Over 65 Credit Over 65 Circuit Breaker Credit
Name of Applicant (owner or contra b er) Telephone Number Em d Address
V 4a\rcn C°0D )6� ,
Appli a th Sol Legal or Equitable Owners If No, What is Applicant's Exact Share or Interest? If Owned with Joint Tenant or Tenant in Common, Indicate with Whom
es ❑No
If Name on co is Different than Applicant. Indicate Below Do All Joint Tenants or Tenants in Com on Reside on the Property?
Yes ❑ No
Name of Contract Seller Has Applicant Owned or Bought the Prop rty Under Recorded Contract
for at Least One(1)Year before Claim g redit?
Yes ❑ No
Address of Contract Seller (number and street, city, state, and ZIP code) Is the roperty in Question.
eal Property ❑ Mobile Home (IC 6-1.1-7)
Taxing District Key Number / Legal Description Record Number Page Number
. CD7A -2..3 - 1 '3 =3Go - OOI . 1\\AA
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?
$
IIWe certify under penalty of perjury that the above and foregoing information is true and correct.
Sign r of Applicant Date (month, day, year)
on
3 ' 07-0-2- -C--
ddress of Applic nt (number and street. city. state, and ZIP c
\2-6 6ii -S LIG u3 - 1:k.)0,A9 - 54) EED .
Signature of Authorized Representative Date (month. day. year)
Address of Authorized Representative (number and street, city, sta}A*1d 4lPPod.)
11�� 2026
Signatur ou ty A 'tor iLli_ _ _ ___G7is/-72.s„fol
_. Date (month, day. \at
ouNTY Auord�
R
DISTRIBUTION: Original - County Auditor; File-Stamped Copy - Taxpayer