HomeMy WebLinkAboutAge_Rish ctIs APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
et PROPERTY TAX BENEFITS
l State Form 43708(R13/4-15) Ma
' Prescribed by the Department of Local Government Finance
i rk
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. i i
INSTRUCTIONS:To be filed in person or by mail with the County Auditor of the county where the property is loca®x:T 16 2018
Filing Dates: 1) Real Property:Form must be completed and signed by December 31 and riled or postmarked by the following January 5.
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as real prop y:Dud t e 12)months
before March 31 of the year the deduction is to be effective.
See reverse side for additional instructions and qualifications. GIBBON COUNTY AUDITOR
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 contract buyer) (=,"1/�'rl`'-'/f�,1}''�—1
Is applicant the so legal or owner? If No,what is his/her exact share or interest? If owned with joint tenant or tenant in common,
indicate with whom
El 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 vying 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 ❑ Mobile home(IC 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
8h -)av - ate- Oo 5)017,38
Does applicant reside on property? Assessed value of the property as of current year a«xsment date(may not exceed
$182,430 for Over 65 Deduction or 8159,999(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
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
525,000;for the Over 65 Circuit Breaker Credit, income may not
exceed$30,000 for individuals or 540,000 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?
El Yes ❑ No
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature o applicant 4, Address of applicant (number and street,city,state,and ZIP code)
3ov a gico S t
/ri m-eel4A., TA/ 1767D
Signatur of auth rized representative Ad ass of authorized representative (n mbar and street,city,state,and ZIP code)