HomeMy WebLinkAboutAge_Swinehart ���"�'�q. APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
�'' y. PROPERTY TAX BENEFITS
a/ State Form 43708(R13/4-15) g
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'r Prescribed by the Department of Local Government Finance Q
VI 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 CounfyAuditor 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
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Over 65 Deduction from Assessed Valuation ❑ Over 65 Circuit Breaker Credit
1
Name of licant(o ner contract buyer)
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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,
indicate with whom
) Yes ❑ No
If name on record is different)(Yes
that of applicant,indicate below !� ' Do all joint tenants or tenants in com on reside on the property?
NOV 13 Z019 Yes ❑ No
Name of contract seller Hasa applicant owned or been bu pp g t openly under recorded
contract for at least one(1)year befo c a mg deduction?
Yes ❑ No
Address of contract seller(number and street,city,state,and ZIP code) the property in question:
GIBSON COUNTY AUDITOR
❑ Real property ❑ Mobile home(IC 6-1-1-7) •
Taxing district Key number/Legal description Record number Page number
' �n\\e .
0 ck6—\S— 303—06, 2 L—o _2
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$159,999[counting just the homestead site]for the Over
❑ No 65 Circuit Breaker Credit.)
❑ YesSee 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 C -2.—Lc-i---
. 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 [00 20{�w , $ 1. Lk0 sJQ
$25,000;for the Over 65 Circuit Breaker Credit,income may not f -
exceed$30,000 for individuals or$40,000 for married couples.). $
See reverse for details. TOTAL $ 0.00
Have you filed for any other deductions? If Yes,what deductions?
Yes
NJ ,.`Jj.o \ a � -e
Have you filed for deductions in any other coun j If Yes,what county?
❑ Yes Klo •
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Sign 0 of applicant Address of applicant (nu ben and st ee c state,and ZIP code) \(
,6„ J 1,04(diake- 1\ CACI 0 N'l \c -3 ,,_.„..,. ,
Signature of authorized representative Address of authorized representative (number and street,cityistate,and ZIP code)