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4'M4 " •4 APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
41 Alt PROPERTY TAX BENEFITS
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State Form 43708 (R19 7-25) Lk bai\ 2-04- AWA c5Qa3
'ma Prescnbed by the Department of Local Government Finance - 1
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 check all that apply)
Over 65 Credit ver 65 Circuit Breaker Credit
Name of Applicant (owner or contract buyer)
Owned with Joint Tenant or Tenant in Common. Indicate with Whom
l.2 es ❑N° ,
If Name on Record is Different than Applicant. Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property?
es ❑ No
Name of Contract Seller Has Applicant Owned or Bought the Property Under Recorded Contract
for at Least One(1)Year before Claiming Credit?
Es ❑ No
-
Address of Contract Seller (number and street, city, state, and ZIP code) Is the Property in Question.
eat Property ❑ Mobile Home (/C 6-1.1-7)
Taxing District f Key Number/ 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 es ❑ 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 eS
• m er 31 of the Year Pnor to the Year Taxes are First Due& Payable? ElNo
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IlWe certify under penalty o perjury that the above and foregoing information is true and correct. �b
Signature o Applicant Date (month, day, year) \
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Addre f pelican (nu b,r and street, city, state. and ZIP code)
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Signature of Authonzed Representative ^Dat- oath, day. year)
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Address of Authorized Representative (number and street, city, state. and ZiP code)
Signature of County Auditor Date (month, day, year)
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DISTRIBUTION: Onginal - County Auditor; File-Stamped Copy - Taxpayer