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State Form 43708 (R14 / 10-17)
Prescribed by the Department of Local Government Finance
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9.
File Mark

INSTRUCTIONS: To be filed in person or by mail with the County Auditor of the county where the property is located.

Filing Dates: 1) Real Property: Form must be completed and signed by December 31 and filed or postmarked by the following January 5. 2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as real property: During the twelve (12) months before March 31 of the year the deduction is to be effective.

Click here for additional instructions and qualifications.
Type of benefit requested (Please check all that apply.)
Name of applicant (Last, First)
Is applicant the sole legal or equitable owner?

If name on record is different than that of applicant, indicate below.
Do all joint tenants or tenants in common reside on the property?
Name of contract seller
Has applicant owned or been buying the property under recorded contract for at least one (1) year before claiming deduction?
Address of contract seller (number and street, city, state, and ZIP code)
Is the property in question:
Taxing district
Key number / Legal description
Record number
Page number
Does applicant reside on property?
Assessed value of the property as of current year assessment date (May not exceed $182,430 for Over 65 Deduction or $159,999 [counting just the homestead site] for the Over 65 Circuit Breaker Credit.)
Is the applicant 65 years of age or more on December 31 of the year prior to the year taxes are first due and payable?

Applicant's date of birth (mm-dd-yyyy)
If filed by a surviving, unmarried spouse, what was the spouse's age at the time of death?
Adjusted Gross Income (AGI) of applicant, applicant and spouse, or applicant and joint tenants or tenants in common, as applicable (For Over 65 Deduction, AGI may not exceed $25,000; for the Over 65 Circuit Breaker Credit, AGI may not exceed $30,000 for individuals or $40,000 for married couples.).

Source of Income

Amount of Income $


Have you filed for any other deductions?
Have you filed for deductions in any other county?
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of applicant
Date (mm-dd-yyyy)
Address of applicant (number and street, city, state, and ZIP code)
Signature of authorized representative
Date (mm-dd-yyyy)
Address of authorized representative (number and street, city, state, and ZIP code)
Signature of County Auditor
Date (mm-dd-yyyy)
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