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Home My WebLink AboutAge_Folkman "` " APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR _:.4,�..;iiiii , PROPERTY TAX BENEFITS , 1 ' P A v_. State Form 43708(R 19/7-25) 4'c' t P3 1 .4 `-.. �l a[.,Ql`Pf+escribed by the Department of Local Government Finance l` • Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9_ instructions To be filed in person or by marl with the county auditor of the county where the properly is located. Filing Date: Form must be completed, signed, and filed with the county auditor or postmarked by January 15 of the calendar year in which the property taxes are first due and payable. See reverse side for additional instructions and qualifications Type of Benefit Requested (Please check all that apply) ver 65 Credit IUvveer 65 Circuit Breaker Credit Name of Applicant(owner or contract buyer) Telephone Number Email Address rC\ar Le--\\Q -40‘VMalli‘ 6 la) (Q. t - 1-k—1 . is Applicant the Sole Legal or Equitable Owner? If No. What is Applicant's Exact Share or Interest? if Owned with Joint Tenant or Tenant in Common. Indicate with Whom ❑Yesf ❑ No if Name on Record rs Different than Applicant. Indicate Below Do Ail Joint Tenants or Tenants in Common Reside on the Property? ❑aes ❑ No Name of Contract Seller Has Applicant Owned or Bought the Property Under Recorded Contract for at Least One(1)Year before Ctairiing Credit? 0-Yes ❑ No Address of Contract Seller (number and street, city, state, and ZIP code) Is the Property in Question: ` 1 J-Zevil Property ❑ Mobile home ;/C ! ? 1 7 Taxing District Key Number/ Legal Description Record Number Page Number P24 Ace 4c.tQfN Q0 --- t. 1 - t a - 101.-\ - 000 . --1g-- 0 (.(P , Did Applicant qualify for the homestead standard deduction in the preceding year (or was applicant married at the time of death to a deceased spouse who qualified for a homestead standard deduction for the individual's homestead property in the immediately ['Pes ❑ No preceding calendar year)and does Applicant qualify for the homestead standard deduction in the current year? Is the Applicant 65 Years of Age or More on December 31 of the Year Prix to the Year Taxes are First Due& Payable? 9es ❑ No Applicants Date of Birth(month, day,year) If Filed by a Surviving.Unmarred Spouse.What Was the Spouse's Age at the Tine of Death'? �� 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 Over 65 Credt, AGI s may not exceed (1) S60,000 for individuals who fired a single return; (2)$70,000 for Caf 1 1—i ndnviduals who bled a)ant return, or(3) S70.000 for individuals and a/others that i share ownership as gait tenants or tenants in common. For the Over 65 Cult Breaker Credit. AG!may not exceed (1) $60,000 for individuals who Med a stogieSr-15_,.., .___oreturn;or(2)$70,000 for individuals who bled a putt return with the indrvidual'sC-9 ovi- cl . spouse.)(Beginning with Pay 27, income amounts for the Circuit Breaker Credit are annually adjusted_]Sae reverse for details. TOTAL $ I/We certify under penalty of perjury that the above and foregoing intonation is true and correct. Sgna of Applicant -�A Date (month, day, year) _ , -- 4C--e-/ A-f2 (9 iCI Address of Applicant (number awl street, city, state, a code)r. \ \ 0 0 'r--C ) )1--/Le_,J/Of J--- - • 1--\1, V nO Signature of Authorized Representative f / Date (month, day, year) Address of Authorized Representative (number and street, dty, state, and ZIP code) ILEDSignature of County Auditor Date (month, day, \‘.r\(- ,, ,t\. ouz_L a sak_3c-- 1...,c1....)L- /ry, ..k.D• _ 2_.rg.u_ . , MAR 1 6 2026 4 ,c(N, k-- __\___: DISTRIBUTION: Onginal - County Auditor; File-Stamped Copy - Taxpayer "\-y a. iaz,n4) GIBSON COUNTY AUDITOR ` -", APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR _ ce , PROPERTY TAX BENEFITS :: \ +' State Form 43708(R7314-15) • \'®° 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. INSTRUCTIONS:To be filed in person or by mail with the County Auditor of the county where the propert Focc e��D 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 prwry:®tinglig twelve(12)months before March 31 of the year the deduction is to be effective. See reverse side for additional instructions and qualifications. fyem Type of benefit requested(ple a check all that apply) GIBBON COUNTY AUDITOR Over. 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit Name of applicant(owner or contract r "1.44CEA..� I+ t � eitiefMain Is applicant the sole legal or eq-itable owner? If No,w•.t is is/her exact share or interest? If owned with joint tenant or tenant in common, indicate with whom ❑ Ye ■ h.• If name on record is different than that of applicant,indicate below Do all joint tenants or tenants in common reside on the property? V4 ❑ 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) I Is the property' question: 1 A r ' I/��A I• o ll`I o` [j Real property ❑ Mobile home(IC 6-1-1-7) Ta ' strict _lh!-' 1 l `tip CCJJ`` iiKeJeynunumber/ al plasm jon Record number Page number a- II-G -161E-000.54i8flaS' Does applicant reside on property? Assessed value of the property as of current year assessment date(may not exceed 5182,430 for Over 65 Deduction or 5159.999(counting just the homestead site]for the Over rYes ❑ No 65 Ciicuit Breaker Credit.) I� See reverse for details. Is 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,what prior to the year taxes are first due and payable? was the spouse's age at the time of death? LI Yes ❑ No 5_ 5- 45"-g Adjusted gross income of applicant,applicant and spouse,or Source of Income Amount of Income applicant and joint tenants or tenants in common,as �^ applicable(For Over 65 Deduction, income may not exceed �r $ S25,000;for the Over 65 Circuit Breaker Credit, income may not exceed,S,30,000 for individuals or$40,000 for married couples.). S See reverse for details. TOTAL S 0.00 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 applicant �,ry Address of applicant (number and street,city,state,and ZIP code) Signatu of of a�representative Address of authorized representative (number and street,city,state,and ZIP code)