HomeMy WebLinkAboutAge_Kays (2) �; APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
sk� PROPERTY TAX BENEFITS
State Form 43708(R13/4-15)
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: I) 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 lC 6-I.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. 1 t, _ J� m\^ , 1
Do all jiateriants or tenants in common reside on the property?
R-T s ❑ 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?
Li 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
L1/4tY061 C3., aka-It -a -300-00' .0-13 -00u,
Does applicant reside on property? Assessed value of the property as of current year assessment date(may not exceed
3182,430 for Over 65 Deduction or 6159,999(counting just the homestead site)for the Over
C✓ 7e5 ❑ NO 65 Circuit 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
applicable(For Over 65 Deduction, income may not exceed S
$25,000;for the Over 65 Circuit Breaker Credit, income may not
exceed$30,000 for individuals or S40,000 for married couples.). S
See reverse for details. TOTAL $ 0.00
Have you filed for any other deductions? If Yes,what deductions?
Lt�'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.
Signature of applicant Address of applicant (number and street,city,state,and ZIP code)
kl h K k22 06 5 /25O E OC
Signs re of authoriz epresentativef Address of authorized representative (number and street.city,state,and ZIP code)