HomeMy WebLinkAboutAge_Bryant (2)APPLICATION FOR SENIOR CITIZEN
PROPERTY TAX BENEFITS
State Form 43708 (R20 / 5-26)
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
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 check all that apply)
Lll,6//ver 65 Credit Over 65 Circuit Breaker Credit
Name of Applicant (owner or contract buyer)
Telephone Number
Email Address
Is Applicant Legal or Equita O ner?
If No, What is Applicant's Exact Share or Interest?
If Owned with Joint Tenant or Tenant in Common, Indicate with Whom
7Yes❑ No
If Name on Record is Different than Applicant, Indicate Below
Do All Joint Tenants or Tenants in Common Reside on the Property?
�J4es ❑ No
Name of Contract Seller
Has Applicant Owned or Bought the Property Under Recorded Contract
for at Least One (1) Year before Claiming Credit?
[,]'Yes ❑ No
Address of Contract Seller (number and street, city, state, and ZIP code)
Is the in Question:
Property
L/Real Property ❑ Mobile Home (IC 6-1.1-7)
Ta ing District
Key Number / Legal Description
CrI - aQL L50 fr�, qDa
Record Number
Page Number
Does Applicant reside on the real property, mobile home, or manufactured home?
U®s
❑ No
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
❑N'e's
❑ No
preceding calendar year) and does Applicant qualify for the homestead standard deduction in the current year?
Is the Applicant 65 Years of Age or More on December 31 of the Year Prior to the Year Taxes are First Due & Payable?
�/
9- es
❑ No
Applicant's Date of Birth (month, day, year)
If Filed by a Surviving, Unmarried Spouse, What Was the Spouse's Age at the Time of Death?
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 filed a single retum; (2) $70, 000 for
lCJ1
individuals who filed a joint return; or (3) $70, 000 for individuals and all others that
40 ��
$ C) L—
share ownership as joint tenants or tenants in common. For the Over 65 Circuit
Breaker Credit, AGI may not exceed: (1) $60, 000 for individuals who filed a single
return; or (2) $70, 000 for individuals who filed a joint return with the individual's
1
spouse.) [Beginning with Pay 27, income amounts for the Circuit Breaker Credit are
annually adjusted.] See reverse for details.
TOTAL
$
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature o pplicant
Date (montfhl day, year)
A ess of Ape cant (nobpFand street, ci state, and ZIP code)
Signature of Authorized Representative
Date (month, da44yea,l
Address of Authorized Representative (number and street, city, state, and ZIP code) JUL
Signature of County Auditor
Date (monntth�, day, year) � A&&Iw)
`1 `-'R
AUDITOR
DISTRIBUTION: Original — County Auditor; File -Stamped Copy — Taxpayer
o. :- APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
_ y:. PROPERTY TAX BENEFITS
a ` "t = 1 17 1 Ab 1 .
'e. State Form 43708(R13/4-15)
ere Prescribed by the Department of Local Government Finance w
-
Filing Dates: 1) Real Property:Form must be completed and signed.by December31 and filed or postmarked by the following Januarys.
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not asses as real property:During the twelve(12)months ,
before March 31 of the year the deduction is to be effective. 8iZ��O r_-�'��
U
See reverse side for additional instructions and qualifications. aki\ b,
• Type of benefit requested(please check all that apply)
•
[(Over 65 Deduction from Assessed Valuation ❑ Over 65 Circuit Breaker Credit
If name on record is differ nt t n that of applicant,indicate belo �� I.,
Do all joint tenants or tenants in common reside on the property?
'A-Yes ❑ No
Name of contract seller DEC 2 6 2019 Has applicant owned or been b in.t - .roperty under recorded
contract for at least one(1)year bef• c aiming deduction?
Yes ❑ No
Address of contract seller(number and street,city,state,and ZIP code)42A4coa------
Is the property in question:
GIBBON COUNTY AUDITOR Real property ❑ Mobile home(IC 6-1-1-7) •
Taxing district Key number/Legal description . Re rd number Page number
•
) ," 7 6, 712-07 -Zoe► •-000 9-S—02.g,
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.)
Yes See reverse for details.
Is the applicant 65 years of age or more on Dece ber of the year
Have you filed for any other deductions? If Yes,what deductions?
Yes No .1-1i `3}G.0 / iJc
•
Have you filed for deductions in any other county El
Yes,what county?
❑ Yes No •
I]We certify under penalty of perjury that the above an foregoing information is true and correct. r,
representative Address of authorized representative (number and street,city,state,and ZIP code)���
Ire) r. _