HomeMy WebLinkAboutAge_Whittler ‹, , 4e APPLICATION FOR SENIOR CITIZEN
;,I PROPERTY TAX BENEFITS
COUNTY TOWNSHIP YEAR
IN, t1. State Form 43708(R15/
4e7ii `l Prescribed by the Department 1-20)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 Date: Form must be completed and signed by December 31 and filed with the county auditor or postmarked by the following
January 5 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 Deduction from Assessed Valuation ®Over 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer)
Phyllis Whittler
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 than that of applicant,indicate below. Do all joint tenants or tenants in common reside on the property?
!Yes ❑No
Name of contract seller Has applicant owned or been buying the property under recorded contract for
N/A at least one(1)year before claiming deduction? 10 Yes ❑No
Address of contract seller(number and street,city,state,and ZIP code) Is the property in question:
N/A IZI Real property ❑Mobile home(IC 6-1-1-7)
Taxing district
Breaker Credit received before January 1,2020,and$199,999 fall Indiana real
property]for the Over 65 Circuit Breaker Credit initially applied for after December 31,2019.)See reverse for details.
Is the applicant 65 years of age or more on December 31 of the year
spouse's age at the time of death?
Adjusted Gross Income(AGI)of applicant,applicant and spouse,or applicant
individuals spouse.)See reverse for details.
Have you filed for any other deductions? If Yes,what deductions?
EYes ❑No Homestead
Have you filed for deductions in any other county? If Yes,what county?
❑Yes liNo
I/we certify under penalty of perjury that the above and foregoing information is true and correct.
—�,
c oTgnoture or icy 7� /� at:ezreyev'
D�a e rr, to�deyry
....c X ar/ I l E' '��off®
Address of appli nt (nur ber and street cr y,state,and ZIP code)
6388 W Old Princeton R , Owensville, IN 47665
Signature of authorized representative Date(month,day,year)
Address of authorized representative (number and street,city,state,and ZIP code)
Sign ture of County Auditor Date(mon day,year)
,,c - . 4 —ate s . a�
-yol
Ofr 41t' • CO
PQ���
ti
• �� P09\,VpR
�N
Go
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer G\�SQN