HomeMy WebLinkAboutAge_Field (2) n„� APPLICATION FOR SENIOR CITIZEN
�4�, �� COUNTY TOWNSHIP YEAR
y PROPERTY TAX BENEFITS ._
"I`� State Form 43708(R15/1-20) p
•
"` �. /�dsm l `�po�0
„16 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 ch all that apply.)
Over 65 Deduction from Assessed Valuation ❑Over 65 Circuit Breaker Credit
Name fa
licant(owneror.coritract6u r)
Is applicant the le legal, a flab wner? If No,what is his/her exact share or interest? If owned with joint tenant or tenant in common,indicate with whom.
s •❑No
If name on record is differ nt than that of applicant;indicate below. 1 - Do all joint tenants or tenants in common reside on the property?
. . ' DYes ❑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? .
DYes ❑No
Address of.contract seller(number and street,city,state,and ZIP code) i the property in question:'
al property, -•❑Mobile home(/C 6-1-1-7)
Ta ' g district Key number/Legal description Record number Page number
Svc . 210-042 00-in o 3 3 •oaa
Does applicant reside on prop rty? Assessed value of the property as of current year assessment date(May not exceed$200,000 for Over 65 Deduction or$199,999
prop
El 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 after December 31,2019.)See reverse for details.
Is the applicant 65 years o dd age or more on Dece be 1 of the year
$
individual's spouse.)See reverse for details. . .. , . , _ - -
Have you filed for any other dedu ons9 If Yes,what deductions?
Yes ❑No
Have you filed for deductions in any other u ? If Yes,Chat county?
❑Yes o
I/We certify.under penalty of perjury that the above and foregoing information is true and correct. -
XSign t e ofaPPUcant ,Date(month,day,,year)
w �� Q`,Z -.20�Q
Address of licant (numbe and street,city,state,and ZIP code)
Signature of authorized representative Date(month,day,year)
Address of authorized representati a (num era rstreet,ci state,and ZIP c de lc jify.....
Signature of County Auditor Date(month,day,year)
D
FsIE:12'.
8 2020
. . • GIBBON CNTy AUITOR
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer
-� - - - _ .- -- —_ — ■