HomeMy WebLinkAboutAge_Ott .;%'°a APPLICATION FOR SENIOR CITIZEN c u J {o YEAR '
°t PROPERTY TAX BENEFITS �, 1
'r.' State Form 43708(R9/9-08)
•. 1.;. f Prescribed by the Department of Local Government Finance
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Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1A-35-9.
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor of the county where the property is located. GIB$D(hJ COUNTY AUDITOR
• Filing Dates: 1) Real Property:During the twelve(12)months before December 31 of the year the deduction is to be effective.
2) Mobile Homes assessed under IC 64.1-7 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.
See reverse side for additional instructions and qualifications.
Type of benefit requested(please check all that apply)
VOver 65 Deduction from Assessed Valuation ❑ Over 65 Circuit Breaker Credit
Name of applicant(owner or contr^actt buyer)
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Is applicant the sole legal r equitable owner? If No,what is his/her exact share or interest? If owned with someone other than spouse,
indicate with whom
es ❑ No
If name on record is different an that of applicant,indicate below
Name of contract seller(applicant must have been buying on contract at least one(I)year)
Address of contract seller(number and street,city:state,and ZIP code) Is the property in question:
I�{YReal property ❑ Mobile home(IC 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
a(0-( a-Crl -ab -Dos . 053-�t5g
Is the property used and occupied primarily for Assessed value of the property as of March 1,current year(may not exceed 5162,430
his/her residence? �I�pp for Over 65 deduction,or$160,000 for Ne Over 65 Circuit Breaker Credit)
Yes ❑ No
Was the applicant 65 years of age or more on December 31 of the year Applicant's date of birth(month,day,year) If filed by a surviving,unmarried spouse,
prior to the current year? what was the spouse's age at the time
Yes ❑ No of death?
1 b- La-sue _---
Adjusted gross income of applicant, spouse,and any Source of Income Amount of Income
individuals sharing ownership(For Over 65 deduction,income $ ��
may not exceed S25,000;for the Over 65 Circuit Breaker Credit, -__
income may not exceed$30,000 for individuals,or$40,000 for $
married couples).
TOTAL $ 0.00
Have you fled for any other deductions? If Yes,what deductions?
`j Yes ❑ No
Have you filed to deductions in any other county? If Yes,what county?
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❑ Yes rvo
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant was a resident
. of Indiana and owner of the aforementioned property on March 1,20 .
Signature of applicant Address of applicant (number and street,city,state,and ZIP code)
nature of Dried representative Address of authorized representative (number and street,city,state,and ZIP code)
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