HomeMy WebLinkAboutAge_Crouch AAPPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
PROPERTY TAX BENEFITS
'. ./' State Form 43708(R13/4-15)
\a Prescribed by the Department of Local Government Finance
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. 1 I� �
INSTRUCTIONS:To be tiled in person or by mail with the County Auditor of the county where the property is located. fug��r
Filing Dates: 1) Real Property:Form must be completed and signed by December 31 and filed or postmarked by the&Ming JanuaOryII5 .
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as real property:During the twelve 1 )mo hs
before March 31 of the year the deduction is to be effective.
See reverse side for additional instructions and qualifications. G I BSO N COUNTY AUDITOR
Type of benefit requested(WeavOe check all that apply)
❑ ,—,�
O ver 65 Deduction from Assessed Valuation Lei Over 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer)
Hau,etti LU G
Is applicant the sole legal or equitable ow r? If No,what is hinter 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 ro
contract for at least one(1)year fore claiming deduction??
❑ Yes ❑ No
Address of contract seller(number and street,city,state,and ZIP code) Is the property question:
Real property ❑ Mobile home(IC 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
02E)— 0-) - 103-0O3 368 -D0Si
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$159,999(counting just the homestead site)for the Over
❑ 65 Circuit Breaker Credit.)
❑
Yes NO 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 111 No
Have you filed for deductions in any other county? If Yes,what county?
❑ Yes ❑ No
INJe 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)
� /il/.,� b o s- Ok — Pt�i J,cob 7o
Signa ? f authorized
represen ative Address of authorized representative (number and street,city,state,and ZIP code)