HomeMy WebLinkAboutAge_Maier 9 a.r APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
�� 4 PROPERTY TAX BENEFITS
1 State Form 43708(R15/1-20) gA �/� %J��Prescribed by the Department of Local Government Finance `� hita,4 `"�2.0
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
Is applicant the sole legal or equita le owner? If No,what is his/her exact share or interest? If owne ith 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?
WIYes 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?
WIYes ❑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
FT. BRANCH 26-19-19-102-000.473-026
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
®Yes ❑No [counting just the homestead site]for the Over 65 Circuit BreakerCredit received before January 1,2020,and$1199,999[all Indiana real
property]for the Over 65
, —
Have you filed for deductions in any other county? If Yes, at county?
Eyes No i3C41-`
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Cigna a of pelican Date(month,day,year)
-- 7- z- 2DzD
Address of applicant (number and streefci state,and IP code
L304 hi. j 2( . Jj1h71/P AllY
Signature of authorized representative Date(month,day,year)
IAddress of authorized representative (number and street,city,state,and ZIP code)
Signature of County Auditor Date(month,day,year)0 et 2 90ZZ
3U� C.
GIBSON COUNT, R
10
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer
4/2a -yzailv