HomeMy WebLinkAboutAge_Church . 1�,.r,2 ���, �,�� APPLICATION FOR SENIOR CITIZEN couruTY /_ ,�•.�t�,�,fj�AEARp iN PROPERTY TAX BENEFITS
t State Form 43708(R13/4-15)
lets esPrescribed by the Department of Local Government Finance
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Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. ,
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INSTRUCTIONS:To be filed in person or by mail with the CountyAuditor of the county where the property is located. ON CO/IAis.-4
Filing Dates: 1) Real Property:Form must be completed and signed.by December 31 and filed or postmarked by the followingUtth , -P
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as real property:During the twelve(12)�pjhs
before March 31 of the year the deduction is to be effective. OR
See reverse side for additional instructions and qualifications. -
• Type of benefit requested(please check all that apply) \ ,,�
--,K.
Over 65 Deduction from Assessed Valuation �J Over 65 Circuit Breaker Credit
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Name
his/her exact share or interest? If owned with joint tenant or tenant in common,
indicate with whom
"*-14s ❑ No
If name on record is different than that of applicant,indicate below Do all joint tenants or tenants in common reside on the property?
❑:Yes El 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?
El 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) '
Taxin: . -rid Key number/Legal description Record number Page number
A—/07-07Jo3 -Ow. 96 -Dqp
Does jiplicant 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 tcounfing just the homestead site]for the Over
❑ No 65 Circuit Breaker Credit.)
."-XYes 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?
El Yes ❑ No
Adjusted gross income of applicant,applicant and spouse,or
Have you filed for any other deductions? If Yes,what deductions?
❑ Yes ❑ No
Have you filed for deductions in any other county? If Yes,what county?
El Yes ❑ No
I/We certify under penalty of perjury that the above and foregoing information is true and correct. s
Signature of applicant Address of applicant (number and street,city,state,and ZIP code) -6 4 GU /b
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