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4 APPLICATION FOR SENIOR CITIZEN COUNTY , TOWNSHIP . YEAR
*1;6 EPROPERTY TAX BENEFITS, � State Form 43708 (R19 I 7-25) 3Lsitie) 0 R
20 2 y
• e Prescribed bythe Department of Local Government Finance 1
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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 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.
See reverse side for additional instructions and qualifications
Type of Benefit Requested (Please check all!ha ply) T
Over 65 Credit Der er 65 Circuit Breaker Credit
ame of Applicant ( wner or contract buyer)
with Joint Tenant or Tenant in Common. Indicate with Whom
r es ❑ No
If Name on Record is Different than Applicant. Indicate Below Do All Joint Tenants or Tenants in om •• Reside on the Property?
AP Yes ❑ No
Name of Contract Seller Has Applicant Owned or Bought the Pr...:, Under Recorded Contract
for at Least One (1)Year before Claiming Credit?
s ❑ No
Address of Contract Seller (number and street, city, state. and ZIP code) Is the Property in Question
Real Property ❑ Mobile Home (IC 6-1 1-7)
Taxing Distnct Key Number / Legal Description Record Number Page Number
NA 2-h 2-02--52 _ 30?-02 • -a 9 -
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?
/7 —
$
lN1le certify under penalty of penury that the above and foregoing information is true and correct. - — Al
Signs re of Applicant Date (month, day. year)
* . 4 1' 41: CC O
Address of Applicant (number and reef. city, state, and ZIP Code) Cci
O p
I e 9 i 3rd a.,q le_I--y)
' 21\1 Lf-7(..°4-0 LINE)
Signature of Authonzed Representative "11.4
1 Date (month, day. year)
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Address of Authorized Representative (number and street, city, state, and ZIP code) Q
411114 •
— • .
Signature of Coun Auditor 0 . Date (month, day. year) _m
DISTRIBUTION: Original - County Auditor: File-Stamped Copy - Taxpayer