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HomeMy WebLinkAboutAge_King l I el;)",. . APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR 7 PROPERTY TAX BENEFITS 1 t ` State Form 43708(R13/4 15) GG se ' 1 F+ I ei,,�,2 b'2e Prescribed by the Department of Local Government Finance J 9 File Mark Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. fa/ 1 — 5-3 2 INSTRUCTIONS:To be filed inperson or mail with the County Auditor of ►t h �- kit 7 y tythe county where the property is located. Filing Dates: 1) Real Property:Form must be completed and signedby December 31 and filed or postmarked by the following January 5. ~ 2) Mobile Homes assessed under IC 6-1.1-7 or manufactured ho 1. assessed as real property:During the twelve(12)months . before March 31 of the year the deduction is to be effective. ilig See reverse side for additional instructions and qualifications. ` C 2 2 2J CZ _ •• Type of benefit reque ed( ease check all that apply) � Over 65 Deduction from Assessed Valuation ❑ Over 65 Circuit Breaker Credit Name of applicant owner r contract buyer)• J ,ea1 Is applicant the sole legal or equitable owner? If No,what is s/h r exact share or interest? If owned with joint tenant or tenant in common, indicate with whom Yes ❑ No If name on record is di even han that of applicant,indicate below I.L Do all joint tenants or tenants in common reside on the property? Yes ❑ No Name of contract seller Has applicant owned or been buying t e property under recorded FEB 2 7 2020 contract for at least one(1)year be re laiming deduction? Yes ❑ No Address of contract seller(number and street,city,state,and ZIP code) .��` �' Is the property in question: gip F3ty v6UN7'Y�(�D Real property E Mobile home(IC 6-1-1-7) Taxing district Key number/Legal description AUDITOR Re ord number Page number 26— 19.1Ct— l 0 l —000 .LASC o26 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 De mbe 1 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? 1 was the spouse's age at the time of death? �'' Yes III No No 1 • l 2• 1 . Adjusted gross income of applica ,ap• ' ant 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 I av e s ?VlCt • $ $25,000;for the Over 65 Circuit Breaker Credit,income may not O.) exceed$30,000 for individuals or$40,000 for married couples.). $ 2-2) • • See reverse for details. TOTAL $ 0.00 Have you filed for any other deductions? If Yes,what deductions? , Yes ❑ No 1 1 S J % Have you filed for deductions in any other county? If Yes,what county? ❑ Yes �i No I/We certify under penalty of perjury that the above a • foregoing information is true and correct. Signature applicant C Address of applicant (number and street,city'state,and ZIP code) WRYGvicii • re of authorized represents Address of authorized representative (number and street,cr�state,and ZIP code) APPLICATION FOR SENIOR CITIZEN PROPERTY TAX BENEFITS State Form 43706 (R1917-25) ire `�• 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 r1 i✓ i�--507 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 tho 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) ❑•Over 65 Credit ❑Over 65 Circuit Breaker Credit Name of Applicant (owner orcgntract buyer) Telephone Number d �0 Email Address �a61 Is applicant the Sole Legal or-Equit9ble Owner? If No, What is Applicant's Exact Share or Interest? If Owned with Joint Tenant or Tenant In Common, Indicate with Whom I Yes ❑ No If Name on Record is Different than Applicant, Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property? [1-Yes ❑ No Name of Contract Seller Has Applicant Owned or Boughtthe Property Under Recorded Contract for at Least One (1) Year before ClaimingCredh? Mies ONo Address of Contract Seller (number and street city, state, and ZIP code) / /� Is the Property in Question: ✓J jy, .L. �: , ;�{C'ft%.��[/� ❑Real Property ❑Mobile Home (IC 6-1.1-7) Taxing District Key Number // Legal Description 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 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? ❑ Yes ❑ 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? L V / / I 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 Credi, AGI may not exceed. (1) $60, 000 for individuals who fried a single return, (2) $70,000 for individuals who filed a joint return, or (3) $70,000 for individuals and all others that $ r 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 spouse.) [Beginning with Pay 27, income amounts for the Circuit Breaker Credit are annually adjusted.] See reverse for details. TOTAL $ IIWe certify under penalty of perjury that the above and foregoing information is true and correct. Slgnature,of Applicant ' Date (month, d y, year) Jr of Applicant (number and sheet, city, state, and ZIP code —_'-,, 2-7 LI Signature of Authorized Representative Date (month, day, year) Address of Authorized Representative (number and street, city, state, and ZIP code) U Signature of County Auditor Date (month, day, year)�I %� �1 r 1L— r_ 1 DISTRIBUTION: Original — County Auditor, File -Stamped Copy — Taxpayer r ! 0 � 11 cam, N� 1 \gSO,