HomeMy WebLinkAboutAge_Rhodes Ems• APPLICATION FOR SENIOR CITIZEN /NTY TOWNSHIP YEAR
° y PROPERTY TAX BENEFITS
j"-'I'� State Form 43708(R15/1-20) I ill' s Prescribed by the Department of Local Government Finance J
2020
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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 o iiiprequested(Please hec II that apply)
iwfr/W114.4 65 Deduction from Assessed Valuation ❑Over 65 Circuit Breaker Credit
a p.f buyer)�/�ow: '
V 001. t,1-�
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.
es ❑No
If name on record is differed than that of applicant,indicate below. . Do all joint tenants or tenants in common res de�on the property?
WSJ Yes ❑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? es ❑No
Address of contract seller(number and street,city,state;and ZIP code) Is the roperty in question: ' •
Real property ❑Mobile home(IC 6-1-1-7)
Taxi rict Key number/Legal description Record number Page number
15XL tfOrnWA j 2Lo — 1'7,-rot- 4f®v-coy- 206, o J
Does applicant ressg�le 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 Breaker Credit received before January 1,2020,and$199,999[all Indiana real
_• _ property]for the Over 65 Circuit Breaker Credit initially applied for aferDecember 31,2019.)See reverse for details.
Is the applicant 65 years of age or more on December 31 of the year
/ /�f
Yes III No C �� // r�4-T// // Tg4
Have you filed for deductions in any other�°unnty? If Yes,what county? ,/
El Yes LTVo
I/We certify under penalty of perjury that the above and foregoing information is true and correct. •
re of applicant Date(month,day,year)
Address of applicant (number and street,city,state,and ZIP co" I /�, r ,�76s.
7 xitp,. V .,S/2 /las, f 2i?sv .�• /�
Signature of authorized representative Date(month,day,year)
Address of authorized representative (number and street,city,state,and ZIP code)
•
Sig r CountyAriditor Date( onth,day,year)
,tA- . f - 22,-2
c.) FILED
SEP 2 2 2020
GIBBON COUNTYALID OR
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer ti,
GIBSON COUNTY I,,I -i OR