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t~` ""•4 APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR -�5
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z'r- t PROPERTY TAX BENEFITS
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State Form 43708 I R 19 / 7-25 &af
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,ie• Prescnbed 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 property taxes are first due and payable.
See reverse side for additional instructions and qualifications. (
Type of Benefit Requested (Please the all that apply)
Over 65 "redit _ Over 65 Circuit Breaker Credit
N e of Applicant (ow r or contract buyer) hepe N r ail Address
cf\CA\i6 cue Is Ap ' egal or Equitable O n1 If No, W is A n s Exact Share or Interest? If Owned with Joint Tenant or Tenant in Common, Indicate with Whom
Yes ❑ No , l
If Name oryfie rd is Different than Applicant, Indicate Below J A y 13 2026 Do All Joint Tenants or Tenants in Comm n Reside on the Property?
Yes ❑ No _
Name of Contract Seller Has Applicant Owned or Bought the rop rty Under Recorded Contract
t'.i /J for at Least One (1)Year before Claiming it?
`I d (u,NTY...11l���►►a�A�UDITOR l - — Yes ❑ No
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Address of Contract Seller (number and street, city, state. an7Pcoo ) Is th Property in Question.
eal Property ❑ Mobile Home (IC 6-1 1-7)
Taxing Distnct Key Number 1 Legal Description Record Number Page Number 1
0 0 S . 2_ 6--ew , 02_4koi_‘ .... coos 06 --o 0,/ .
Did Applicant qualify for the homestead standard deduction in the preceding year (or was applicant marned 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?
$
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
gnature of Applicant Date (month, day, year)
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ddress Ap iC nt (numb1and street, city, state, ZIP code ��
11 _.13 Signature of Authonzed Repres t tive Date (month, day. year)
Address of Authorized Representative (number and street, city, state. and ZIP code)
Signature of County Auditor Date (m th, da , year)
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DISTRIBUTION: Original - County Auditor; File-Stamped Copy - Taxpayer