The URL can be used to link to this page

Home My WebLink AboutAge_Johnson (3)11 APPLICATION FOR SENIOR CITIZEN PROPERTY TAX BENEFITS Slate Form 43708 (R1917-25) Prescribed by the Department of Local Government Finance Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. COUNTY TOWNSHIP YEAR C Instructions: To be filed in person or by mail with the county auditor of the county where the property is located. Filing Date: Form must be completed, signed, and filed with the county auditor or postmarked by January 15 of the calendar year in which the property taxes are first due and payable. See reverse side for additional instructions and qualifications. Type of Benefit Requested (Please all that apply) GOver 65 Credit Over 65 Circuit Breaker Credit Name of rant caner or con fi er) �CNII ` rnt Telephone Number E it Address Is Apiflican e e Legal or Equitable Owners If No, What is Applicant's Exact Share or Interest? If Owned with Joint Tenant or Tenant in Common, Indicate with Whom Yes ❑ No If Name on Oac is Different than Applicant, Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property? es ❑ No Name of Contract Seller Has Applicant Owned or Bought the Pu6pertyynder Recorded Contract for at Least One (1) Year before Claimi Yes ❑ No Address of Contract Seller (number and street, city, state, and ZIP code) Is e P operty in Question: Real Property ❑ Mobile Home (1C 6-1.1-7) Taxing District � Ke y Number /Legal Description (� [ Z—`$_QZ—(�J00v—� Record Number Page Number Did Applicant qualify for the homestead standard deduction in the preceding year (or was applicant married at the time of death to a deceased spouse who qualified for a homestead standard deduction for the individual's homestead property in the immediately YeS ❑ No preceding calendar year) and does Applicant qualify for the homestead standard deduction in the current yeah Is the Applicant 65 Years of Age or More on December 31 of the Year Prior to the Year Taxes are First Due & Payable? Yes ❑ No Icant's Da a of Birth month, day, yeao 9 Fred by a Surviving, Unmarried Space. W tie Spouse's Age at the Time of Death? -1l 26 s-3 Source of Income Amount of Income Adjusted Gross Income (AGI) of applicant, applicant and spouse, or applicant and joint tenants or tenants in common, as applicable (For Over 65 Credit AGI $ may not exceed: (1) $60, 000 for individuals who Bed a singe return, (2) $70,000 for individuals who filed a joint return, or (3) $70,000 for individuals and al others that share ownership as jrwrt tenants or tenants in common. For the Over 65 Circuit Breaker Credit AGi may not exceed: (1) $60,000 forindividuals who Bed a single n C�� $ 5 S,' return, or (2) $70, 000 for individuals who filed a joint return with the irdividual's spouse.) (Beginning with Pay 27, income amounts far the Circuit Breaker Credit are annually adjusted.] See reverse for details. TOTAL $ Me certify under penalty of perjury that the above and foregoing information is true and correct. Signature of Applicant Date (month, day, year) , c5 J�L, �,, I Address of Applican umber anotreet city, state, and ZiP code) AA//�� S C �'1Yi C �� `�b�r� t1 �i "Y/v' 1 Signature of Authorized Representative Date (month, d es0 0�� Address of Authorized Representative (number and street city, state, and ZIP code) Signature of Coun for Date (month, d y, ye 7j 1 DISTRIBUTION: Original — County Auditor, File -Stamped Copy — Taxpayer (t � dj"="a APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR 'd - PROPERTY TAX BENEFITS JIb S� n �� . S` / State Form 43708(R13/4-15) ao 'su` 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 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 following January 5. 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. See reverse side for additional instructions and qualifications. Type of benefit requested(please check all that apply) n Over 65 Deduction from Assessed Valuation (JQ Over 65 Circuit Breaker Credit Name of applicant(owner or contract buyer) rtaci, 3ohnsof . Is applicant the sole legal or equitable owner? If No,what is his/her exact share or interest? If owned with joint tenant or tenant in common, Xn' indicate with whom Yes ElNo It name on record is differthat of applicant,indicate below Do all joint tenants or tenants in common reside on the property? AILED kYes ❑ No Name of contract seller Has applicant owned or been buying th property under recorded contract for at least one(1)year before claiming deduction? APR 9 2019 ❑ Yes ❑ No Address of contract seller(number and street,city,state,and ZIP code) Is the property in question: ' , ' al Real properly�A —j• p p y ❑ Mobile home(IC 6-1-1-7) Taxing district GBs,W C& =•di YdMiR,TOR ecord number Page number Q ' Ara-1g-toe-000?-66- 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 S159,999(counting just the homestead site)for the Over ❑ NO 65 Circuit Breaker Credit) Yes See reverse for details. Is the applicant 65 years of age or more on DeceKS 1 of the year Adjusted gross income of applican , a licant 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 exceedGCNICN) IS S25,000;for the Over 65 Circuit Breaker Credit, income may not exceed S30,000 for individuals or S40,000 for married couples.). TOTAL I S 0.00 Have you filed for any other deductions? �,/ If Yes.what ldeductions? I \Yes ❑ No 14`StCSA / VI Wane Have you filed for deductions in any other county?/ ��/// If Yes,what county? El Yes I JtNo 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) kS ignaluriz�pre ntative ham^ Address of authorized representative (number and street.city,state,and ZIP code)