HomeMy WebLinkAboutAge_Willis APPLICATION FOR SENIOR CITIZEN ccpj NTY TOWNSHIP YEAR
r"':5 PROPERTY TAX BENEFITS \ /�
i .'`1 State Form 43708(R15/1-20) \ ,SQ \ 0 a g g,O
n Prescribed by the Department of Local Government Finance
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Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. I L y
INSTRUCTIONS: To be filed in person or by mail with the County Auditor of the county where the property is located. 2OZ�
Filing Date: Form must be completed and signed by December 31 end filed with the county auditor or postmarked by
��aV fo trig
January 5 of the calendar year in which the property taxes are first due and payable.
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See reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR
Type of benefit requested(Please check all that apply.)
Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of (ownercontractq�r) () n !1
Ia applicant the��lloo legal or equitable owner? rest? If owned with joint tenant or tenant In common,indicate with whom.
Yes D No
If name on record Is diffe nt than that of applicant,Indicate below. 0 II joint tenants or tenants In common reside on the prop
//V)(�-,(,y ,/►_S _..Klan,,,(j��'�Yea DON 0
Name of contract seller Has applicant wttad or beenbuying thepropounder rttco ded contract for
^ at least one(1)year before claiming deductiorrrrrrfffiif f'''"' D Yes D No
Address of contract seller(num r end street,city.state.and ZIP code) t property in question:
�^ Real property D Mobile home(IC 6-1-1-7)
�at9 III rlcyj t _ j„_ - Key be /L 1 description Record number Page number
�` ,J 11 /V"(`r`Jlt/Uf l/�/�-.--- o-� -o^t -�+ of -05oo, 458-Dam
Does applicant reside on ?�ppyry Aau sad just
he hfmthe homestead
tytej 10 of current yCircuit Breaar ks Crednt it(Mnvca/vad before Januar 2020 arrr6;1999 i fall nd ana•9real
Or propiot exceed
s
(counting just the homestead sltal for the Over 65
Yes Q No props )Ior the Over 65 Circuit Breaker Credit initially applied for after December 31,2019.)See reverse for details.
Is the oaphec t5 a years
of fagt due and payable?more on
31 of the year
prior yearD Yes D No
Adjusted Gross income(AGl)of applicant,applicant end spouse, •
end joint tenants or tenants in common,as applicable(For Over 65
AGI may not exceed:(1)$30,000 for individuals who filed a single retu
540.000 for individuals who filed a joint return:or(3)640,000 for indiold
Others that share ownership as joint tenants or tenants in common.For
Circuit Breaker Credit.AGI may not exceed:(1)$30.000 for Individuals
single return;or(2)640.000 for individuals who bled a joint return with t
Have
fora.)see reverse for details.
Have you filed any other deductions? It Yes.whet deductions?
D Yes E No
Have you filed for deductions in any other c¢untye If Yes.what county'?
Yes No
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of applicant /JJr)
• f f� � Date(month.day. as_
•
Ay,Q 1 1 fpnt (`(y(�;ear`•ye`—n'ld street,dty,st 4 d Z ye) n Q --T7C / .L�.. 7 G—7 C)
Signature of authorized representative I �_/ Data(month,day.year)
Address of authorized representative (number and street,city.state.and ZIP code)
t e r c ^p Aid+ty^ Q /� C�� _ 11/��}1 Data(month,day, o�
C�C�/ ) Sl t/k )L3
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DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer