HomeMy WebLinkAboutAge_Rosenberger `77`'a� APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
k.-. 4 PROPERTY TAX BENEFITS
I
r• State Form 43708(R73/4-15)
‘l 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 tiled in person or by mail with the CountyAuditor of the county where the properly is located. f®gg®ftt
Filing Dates: 1) Real Property:Form must be completed and signed by December 31 and filed or postmarked by t oil . dad u
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as real property:During the twelve(12)months
before March 31 of the year the deduction is to be effective. SEP 11 2018
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See reverse side for additional instructions and qualifications. 1,�/
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Type of benefit requested e check all that apply) �p
Over 65 Deduction from Assessed Valuation • F" Over 65 Circuit Breaker Credit OON 1`,r AUDITOR
Name of applicant(owner or contract buyer)
J o fn postt,) e,A-,
Is applicant the sole legal or equitable o er? If No,wh t i his/her exact-share or interest? If owned with joint tenant or tenant in common,
indicate with whom
r 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 Hasa applicant owned or been bu
ying eyieg 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 i uestion:
Real property ❑ Mobile home(IC 6-1-1-7)
Taxing district Key number/Legal description VU. Record number Page number
6 d± 6 -1c1 -31 -3n3-ovu4 III 1
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
❑ NO 65 Circuit Breaker Credit.)
Y
See reverse for details.
Is the applicant 65 years of age or more on D the year
— '
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 AG- $
S25,000;for the Over 65 Circuit Breaker Credit, income may not
exceed S30,000 for individuals or S40,000 for married couples.).
5 0.00
Have you filed for any other deductions? If Yes,wkt deductions?
❑ Yes l7
Have you filed for deductions in any other county? If Yes,what county?
❑ Yes o
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)
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X �//��{�tty "'y1-°"`. A �`' . 0 1 S ?ce Z S I ,
SAr6ture of authorized representative Address of authorized representative ((umber and street,city,state,and ZIP code)