HomeMy WebLinkAboutAge_Douglas (2) eilk APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP I YEAR
<e PROPERTY TAX BENEFITS
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\t - - r State Form 43708(R13/4-15)
Prescribed by the Department of Local Government Finance
File Mark
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. �p�'',t T T
INSTRUCTIONS:To be filed in person or by mail with the County Auditor of the county where the property is locate
l� I L E D
Filing Dates: 1) Real Property:Fonn must be completed and signed by December 31 and filed or postmarked by the folloowingJannupar 5.
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as real property:DtMtYth®t8el��t12)months
before March 31 of the year the deduction is to be effective. �/
See reverse side for additional instructions and qualifications. /)/ • ly..Q?(
Type of benefit requested(please check all that apply) �� GIBSON COUNTY AUDI'UK
Ri er 65 Deduction from Assessed Valuation L✓ Over 65 Circuit Breaker Credit
Name of applicant( n�eerr or contract tbbuyyer) 1//\��,�
Is applicant the sole legal or equitable owner? If�If No.what" h er exact share or interest? If owned with joint tenant or tenant in common,
indicate with whom
es ❑ 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 before claiming deduction?
❑ Yes ❑ No
Address of contract seller(number and street,city state,and ZIP code) Is the property in question:
❑ Real property I I Mobile home(IC 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
a( la-D1Q03— OD 69 8
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 5159,999[counting just the homestead site)for the Over
❑ NO 65 Circuit Breaker Credit.)
❑ Yes See reverse for details.
Is the applicant 65 years of age or more on December 31 of the year
Have you filed for any other deductions? If Yes,what deductions?
❑ Yes ❑ No
Have you filed for deductions in any other county? If Yes,what county?
❑ Yes ❑ No
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of applicant Address of applicant (number and street.city,state,and ZIP code)
� y o 1 2 5 .�. Pti ?670*
ign re of authorized r resentative Address of authorized representative (number and street.city,state,and ZIP code)