HomeMy WebLinkAboutAge_Beadle et/-!---it APPLICATION FOR-SENIOR CITIZEN COUNTY TOWNSHIP YEAR
b__- PROPERTY TAX BENEFITS
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=/ State Form 43708(R13/4-15)
\ / Prescribed by the Department of Local Government Finance 7e �
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Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9.
MAY 3 2018
INSTRUCTIONS:To be filed in person or by mail with the County Auditor of the county where the property is located.
Filing Dates: 1) Real Property:Form must be completed and signed by December 31 and filed or postmarked by the ff 'writ_ .'ntal. -
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as real property D k. r 6' (An fibTeR
before March 31 of the year the deduction is to be effective. BB J
See reverse side for additional instructions and qualifications.
Type of benefit requested(please check all that apply)
❑ Over 65 Deduction from Assessed Valuation i Over 65 Circuit Breaker Credit
Name of applicant(owner or cca contract buyer)
Is applicant the sole legal Qr/equitable owner? If Nt is his/her or interest? If owned with joint tenant or tenant in common,
VVV indicate with whom
❑ Yes ❑ 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:
ICReal property ❑ Mobile home(IC 6-1-i-7)
Taxing district /� Key number/Legal description /Record number Page number
.��2 J x-20-6a- y -$ 060 . 039 , i9
Does applican side on property? Accessed value of the property as of current year assessment date(may not exceed
782,430 for Over 65 Deduction or 3159,999(counting just the homestead site)for the Over
5 Circuit Breaker Credit.)
❑ Yes ❑ No
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 $
$25,000;for the Over 65 Circuit Breaker Credit, income may not
exceed$30,000 for individuals or$40,000 for married couples.). S
See reverse for details. TOTAL I $ 0.00
Have you filed for any other deductions? If Yes,what deductions?
.41-29Yes ❑ No ALS
Have you filed for deductions in any other county? If Yes,what county?
❑ Yes ,:Jo
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)
)( 2-� /a 6 A/ �,P �U 1 0 . !Iv 3'7h*
Sig re of authorized representative Address of authorized representative (number and stye cry,state,ands'code)