HomeMy WebLinkAboutAge_Wright (6) KO APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
a/ PROPERTY TAX BENEFITS
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1 State Form 43708(R15/1-20) , � n t�r1
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tee `� 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 the all that apply)
Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
ame of applica
If No, =us his/ lie or interest? • If owned with joint tenant.or tenant in common,indicate with whom.
es ❑No t< t
If name on record is different than that of applicant d cat.). ow.r �\ Do all joint tenants or tenants in common reside on th operty?
�,O es ❑No
Name of contract seller F�Z c�D Has applicant owned or been buying the property under record ntract for
C ®nl� at least one(1)year before claiming deduction? Yes ❑No
Address of contract seller(number and street,city,state,and ZIP code)/]_, J/SPUD\1 Is the p erty in question:
ko-rh�l0V\.\�� eal property ❑Mobile home(IC 6-1-1-7)
Taxing district Key du nb�Q gal description • Record number Page number
On - - 2@\F-Sly—l ?? — I011-000 .?AI -001—
Does applicant reside on prope . 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 ❑No
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
$
individual's spouse.)See reverse for details.
Have you filed for any other deductio ? If Yes,what deductions?,1
Yes III No h d
Have you filed for deductions in any other county? If Yes,what county?
❑Yes pIQo
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of applicant � � �
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Signature of authorized representative Date(month,day,year)
Address of authorized representative (number and street,city,state,and ZIP code)
Signature of County Auditor k Date r5c/th5daytto
......_.:1? Z22 I
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FILED
FEB 2 5 2021
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DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer GIBSON COUNTY AUDITOR