HomeMy WebLinkAboutAge_Johnson (2) / APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
PROPERTY TAX BENEFITS
S' r' State Form 43708(R13/4-15)
•<11 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. F
it
INSTRUCTIONS: To be fled 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 folifftng,,Ia,nruarry� 5.
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as real property:During the R&JNe7t8months
before March 31 of the year the deduction is to be effective.
atiSee reverse side for additional instructions and
ON
qualifcations. GIBS {,
( nJti?Type of benefit requested(please check all that apply)
4LtDITOR�,/ }'
Over 65 Deduction from Assessed Valuation E Uver 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer)
•
Is applicant the sole legal or equitable owner? If No,what is hi er exact share or interest? If owned with joint tenant or tenant in common.
,—, indicate with whom
Ltd 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:
❑ Real property ❑ Mobile home(IC 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
Pc\ rce___Acpn • 0 -I �- cr-/-30,,4 - 90 .QS roaf_
Does applicant reside on property? Assessed value of the property as of current year assessment date(may not exceed
S 182,430 for Over 65 Deduction or S159,999(counting just the homestead site)for the Over
C� 78S ❑ No 65Circuit Breaker Credit)
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?
❑ 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
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.
Sign r f applicant Address of applicant (number and street,city,state,and Z code)
t f�� x7.2/,d" czifo � /7G2zi
i lure of authoriz r ntative Address of authorized representative (number and street,city,state,and code)