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State Form 43708 (R 19 / 7-25
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WO Prescribed by the Department of Local Government Finance
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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 proper o ted. a pit-Z
Filing Date: Form must be completed. signed, and filed with the county auditor or postmarked by ug)79r9) 7St /fbNEblbrld' EN9trf
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) 1
VA0ver 65 Credit ZOver 65 Circuit Breaker Credit I
J
me of Ap.licant ' er or c.ntract buyer)
If Owned with Joint Tenant or Tenant in Common, Indicate with Whom
13Yes ❑No
If Name on Record is Different than Applicant, Indicate Below Do All Joint Tenants or Tenants ' Corn Reside on the Property?
AP Yes _ El No
Name of Contract Seller Has Applicant Owned or Bought t - ' ••Li•• Under Recorded Contract
for at Least One(1)Year before Clarrnng relit?
Yes ❑ No
Address of Contract Seller (number and street, city, state, and ZIP code) Is the Property in Question.
U!:1 Real Property ❑ Mobile Home (IC 6-1.1-7)
Taxi istrict Key Number / Legal Description Record Number Page Number
a4- 3 -/� - you - vdo, 7 s 8 - 0 �.
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 Prior to the Year Taxes are First Due& Payable? Yes n No
annually adjusted.]See reverse for details. TOTAL $
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of Applicant T Date (month. day. year)
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Address of Applicant (number and street, city, state. and ZIP code) + ,
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Signature of Aut nzed Representative Date (month, day. year)
Address of Authorized Representative (number and street, city. state. and ZIP code)
Signature of Cgpnty Auditor Date (month. day, year)
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DISTRIBUTION: Original - County Auditor: File-Stamped Copy - Taxpayer