HomeMy WebLinkAboutAge_Evans ,, R. , APPLICATION FOR SENIOR CITIZEN E•,' E'.. . Ei it .. P YEAR
�;.c�a PROPERTY TAX BENEFITS c ' '\ 00
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"� ,;;�! State Form 43708(R15/1-20) 2020
*° 4— Prescribed by the Department of Local Government Finance DEC 3
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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 propertyBis So at BOUNTY AUDITOR
Filing Date: Form must be completed and signed by
See reverse side for additional instructions and qualifications.
Type of benefit requested(Please check all that apply.)
rg Over 65 Deduction from Assessed Valuation [Over 65 Circuit Breaker Credit
Na applicant(owner or contrart,buyer)
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 different than that of applicant,indicate below. Do all joint tenants or tenants in common reside on the property?
III Yes III 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?
CI 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)
Ta 'ng district r Key number/Legal description Record number Page number
d6- 13 .10 -- oo- 0470.5y 7 -od 4,
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
CI 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 after December 31,2019.)See reverse for details.
Is the applicant 65 years of age or more on December 31 of the year
$
individual's spouse.)See reverse for details.
Have you filed for any other deductions? If Yes,what deductions?
lyIYes ❑No !'T 5, rv( f 9
Have you filed for deductions in any other county? If Yes,what county? ..J
❑Yes XNo
I/We certify u. er.pe alty of perjury that the above and foregoing information is true and correct.
`1 Signature' f' plica.nt Date(month,day,year)
- Address 'applicant.( m and stree ly,state,and ZIP c
:6 A")__ ;,, , .
7 D
igna r f autho ized represents a Date(mont ,day,year)
Address of authorized representative (number and street,city,state,and ZIP code)
Signature of County Auditor , Date(month,day,year)
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DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer