HomeMy WebLinkAboutAge_Davis (2) 4 ""°�. APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
, PROPERTY TAX BENEFITS ,
7;' ter;:;.
. 02a'j• State Form 43708(R13/4-15)
'ia„ '� 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 tiled or postmarked by the following January 5.
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured
Type of benefit requested(please check all that apply)
❑ Over 65 Deduction from Assessed Valuation ❑ Over 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer)_ n
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
Pces ElNo
If name on record is different tthat of applicant,indicate below Do all joint tenants or tenants in common reside on the property?
FILE
Yes ❑ No
Name of contract seller Has applicant owned or been buyi g the iroperty under recorded
contract for at least one(1)year bef re aiming deduction?
JAN 2 2 2020 Yes El
Address of contract seller(number and street,city,state,and ZIP code) _ Is the prop in question:
• eal property ❑ Mobile home(IC 6-1-1-7)
Taxing district Key nrQ I�e Rec rd number Page number
2. G�J-1g r o ^IVN°5c60.11 --022 •
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)
ABS
. Adjusted gross income of applica t,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 exceed See- Pine)ck f.. $l°la 3 e,d
$25,000;for the Over 65 Circuit Breaker Credit,income may not "`'JI
exceed$30,000 for individuals or$40,000 for married couples.). $ �Q
See reverse for details. TOTAL $ 0.00
Have you filed for any other deductions? If Yes,what deductions?
ci
Yes ❑ No ki S ,
Have you filed for deductions in any other coup If Yes,what county?
❑ Yes Xi .
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
ignature pplicant Address of applicant (numbe street city state,and ZIP code)
KS
SO5— L: 1/ 1".4111--—St ,, fp \5-tc t.5-73
Signature of authorized representative Address of authorized representative (number and street,city,state,and ZIP code)