HomeMy WebLinkAboutAge_Callis "a APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
k._ \ PROPERTY TAX BENEFITS III la State Form 43708(R13/4-15)
e.:` 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 property is located. MAY 2 2018
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: fig the elv 4iQ}rlionths
before March 31 of the year the deduction is to be effective.
See reverse side for additional instructions and qua lifications. GIBBON COUNTY AUDITOR
Type of benefit requested(please check all that apply) �yt
❑ Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of appli nt(owner or contract buyer)
Is applicant the sole legal or equitable owner? If No,what is his/her exact share or interest? If owned with joint tenant or tenant in common,
indicate with whom
__ es CI No
If name on record is different than that of applicant,indicate below Do all joint tenants or tenants in common reside on the property?
❑ Yes ❑ No
Name of contract seller Has applicant owned or been buying the property under recorded
contract for at least one(1)year oe,ore claiming deduction?
MCC ❑ Yes ❑ No
Address of contract seller(number and street,city,state,and ZIP code) Is the property in n:
Li Real property ❑ Mobile home(IC 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
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Does applican reside on property? Assessed value of the property as of current year assessment date(may not exceed
$162,430 for Over 65 Deduction or 5159,999(counting just the homestead site)for the Over
El
No 65 Circuit Breaker Credit.)
Yes See reverse for details.
Is the applicant 65 years of age or more on Decemb 31 of the year
Have you filed for any other deductions? �,�' If Yes,what deductions?
CI Yes La No
Have you filed for deductions in any other county? / ` If Yes,what county?
❑ Yes VS
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of applicant 4111A---H Address of applicant (number and street.city,state,and ZIP code)
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Si ature of authorized represents e ddress of authorized representative (number and street city,state,and ZIP code)
APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
4 -. : \ PROPERTY TAX BENEFITS
State Fond 43708 Department 8) g
•� n. Prescribed by the Departm of Local Government Finance JYe ee
YIE
Information contained in this document is CONFIDENTIAL pursuant to IC 6-11-12-9 and IC 6-1.1-35-9.
INSTRUCTIONS:
APR 3 0 2014
To be filed in person or by mail with the CountyAuditor of the county where the property is located.
Filing Dates: 1) Real Property:During the twelve(12)months before December 31 of the year the deduction is to.e •1 ,,•:�� �i
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as real pemistrev bn.the f'14,, 'rLnor7lhs
UIIIJ F(
before March 31 of the year the deduction is to be effective.
See reverse side for additional instructions and qualifications.
Type of beneft requested(please check all that apply)
'Over 65 Deduction from Assessed Valuation , Over 65 Circuit Breaker Credit
Name of applicant((owner or cataract buyet) )
� (1AnetO� (leis-!>
Is applicant the sole legal or equitable owner? If No,what is his/her exact share or interest? If owned with someone other than spouse.
indicate with whom
Yes ❑ No
If name on record is different than that of applicant,indicate below
Name of contract seller(applicant must have been buying on contract at toast one(I)year)
Address of contract seller(number and sheet city,state,and ZIP code) Is the property in question:
❑ Real property ❑ Mobile home(IC 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
ckn-c /6144 -f-- s�6 -19-f -iv V-oa0.013—o ?L ,
Is the property used and occupied primarily for Assessed value of the property as of March 1,current year(may not exceed 5182,430
histher residence? for Over 65 deduction,or$160,000 for the Over 65 Circuit Breaker Credit)
'Yes ❑ No
Was the applicant 65 years of age or more on December 31 of the year
Have you rued for deductions in any other county? If Yes.what county?
❑ Yes t0
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)
< GYIh�Ct�. & ,; <d- Io v y "- - 6119-
Signature of authorized re entative Address of authorized representative (number and stree(city,state,and ZIP code)