HomeMy WebLinkAboutAge_Hensley ti-_
E R.1va� APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
S/= : 4
,._. �1i PROPERTY TAX BENEFITS
iI /x State Form 43708(R15/1-20)
ime`1 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 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)
Bruce Hensley
Is applicant the sole legal or equitable owner? 1 If No,what is his/her exact share or interest? If owned with joint tenant or tenant in common,indicate with whom.
®Yes El 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?
VI Yes El 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? IZ1 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)
Taxing district Key number/Legal description Record number Page number
Columbia 26-14-20-400-000.378-006
Does applicant reside on property? Assessed value of the property as of current year assessment date(May not exceed$200,000 for Over 65 Deduction or$199,999
(counting just the homestead site)for the Over 65 Circuit Breaker Credit received before January 1,2020,and$199,999(all Indiana real
®Yes El No
property]for the Over
Yes ❑No Homestead
Have you filed for deductions in any other county? If Yes,what county?
['Yes IINo
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signafireof appl'icanf 9 Date(month day.year).
Address of applicant (number and street,city,state,and ZIP code)
13003 E 200 S., Oakland City, IN 47660
Signature of authorized representative Date(month,day,year)
Address of authorized representative (number and street,city,state,and ZIP code)
Sign t e of County Auditor Date(month,day,year)
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FILES
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer IOW`
GIBSON COUNTY AUDITOR