APPLICATION FOR COUNTY OPTION                                                                   FOR COUNTY USE ONLY 
                CIRCUIT BREAKER CREDIT                                                              ORDINANCE #                  COUNTY            TOWNSHIP     YEAR 
                State Form 57323 (R / 10-23) 
                Prescribed 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 and signed by December 31 and filed with the county auditor or postmarked by the following 
                 January 5 of the calendar year in which the property taxes are first due and payable. 
See the reverse side for additional instructions and qualifications. 
Name of Applicant                                               Telephone Number                    Email Address 
                                                                (          ) 
If Name on Record is Different than Applicant, Indicate Below 

Did Applicant Receive the Homestead Deduction in the Immediately Preceding Year?                Will Applicant Receive the Homestead Deduction this Year? 
                              ☐ Yes                             ☐ No                                            ☐ Yes                                     ☐ No
Address of Homestead Property (number and street, city, state, and ZIP code)                        Parcel Number 

Taxing District                         Key Number / Legal Description                                                           Is the Property: 
                                                                                                                                 ☐ Real Property              ☐ Mobile Home
Has Applicant Resided in the Homestead for Ten (10) Years or More?                              Date Applicant Started Residing at the Homestead 
                            ☐ Yes                               ☐ No
Is the Applicant Fifty Five (55) Years of Age or Older on December 31 of the Year Prior to the Year the Credit is Being Claimed? Applicant’s Date of Birth (month, day, year) 
                                        ☐ Yes                                                   ☐ No
                                                                                                    Source of Income                                      Amount of Income 
Adjusted Gross Income (AGI) of applicant, applicant and spouse, or applicant and                                                                 $ 
joint tenants or tenants in common, as applicable (For County Option Circuit Breaker 
Credit, AGI may not exceed: (1) the amount identified in the ordinance adopted by the                                                            $ 
county for individuals who filed a single return; or (2) the amount identified in the ordinance 
adopted by the county for individuals who filed a joint return. 
                                                                                                                                                 $ 
See reverse for details. 
                                                                                                                                 TOTAL           $ 
Have You Filed for the Over 65 Circuit Breaker Credit?               If Yes, What County? 
                     ☐ Yes              ☐ No
Have You Filed for Deduction in Any Other County?                    If Yes, What County? 
                     ☐ Yes              ☐ No
I/We certify under penalty of perjury that the above and the foregoing information is true and correct. 
Signature of Applicant                                                                              Date (month, day, year) 

Address of Applicant (number and street, city, state, and ZIP code) 

Signature of Authorized Representative                                                              Date (month, day, year) 

Address of Authorized Representative (number and street, city, state, and ZIP code) 

Signature of County Auditor                                                                         Date (month, day, year) 

DISTRIBUTION:  Original – County Auditor;  File-Stamped Copy – Taxpayer 

                                         INSTRUCTIONS AND QUALIFICATIONS 
                                                           
  GENERAL INSTRUCTIONS 
   
  • Applicants must be residents of the State of Indiana. 
     
  • Applications must be filed during the periods specified. Once the application is in effect, no other filing is necessary 
    unless there is a change in the status of the property or applicant that would affect the deduction. 
  
  • This application may be filed in person or by mail. If mailed, the mailing must be postmarked before the last day of 
    filing.  
  
  • Any person who willfully makes a false statement of the facts in applying for this deduction is guilty of the crime of 
    perjury and on the conviction thereof will be punished in the manner provided by law. 
  
  • Applicant may only claim the County Option Circuit Breaker Credit or the Over 65 Circuit Breaker Credit, but not 
    both. 
 
  BENEFITS 
 
  • For the County Option Circuit Breaker Credit, the county ordinance establishing the neighborhood enhancement 
    district will include the circuit breaker tax credit percentage. The percentage must be at least two percent (2%) but 
    not more than five percent (5%). 
  
  ELIGIBILITY 
   
  • The applicant’s property must be located in the geographic territory designated by the county in the neighborhood 
    enhancement district establishing the ordinance. 
     
  • Applicants must have received the Homestead Deduction under IC 6-1.1-12-37 for their homestead property in the 
    immediately preceding calendar year (or was married at the time of death to a deceased spouse who qualified for the 
    Homestead Deduction for the applicant’s homestead property in the immediately preceding calendar year), and the 
    applicant must receive the Homestead Deduction for the same homestead property in the current calendar year. 
     
  • Applicants must have lived in the homestead property for at least ten (10) years on or before December 31 of the 
    calendar year immediately preceding the current calendar year. 
  
  • Applicants must be fifty-five (55) years of age or older on or before December 31 of the calendar year preceding the 
    year in which the credit is claimed. 
  
  • For the County Option Circuit Breaker Credit, the applicant (either an individual who filed a single return or an 
    individual who filed a joint income tax return) must have an adjusted gross income amount that does not exceed the 
    amount specified by the applicable county ordinance. The Department of Local Government Finance will post the 
    applicable county ordinances on the Department’s website at: https://www.in.gov/dlgf.