HomeMy WebLinkAboutAge_Christie APPLICATION FOR SENIOR CITIZEN � COUNTY TOWNSHIP YEAR
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PROPERTY TAX BENEFITS /� O 7-O 22
44,0) l✓t_ State Form 43708(R15/1-20) S
Prescribed by the Department of Local Government Finance -C2 f.
\�11,✓1 File Mark
Information contained in this document is CONFIDENTIAL pursuant o IC 6-1.1-3 •.
INSTRUCTIONS: To be filed in person or by mail with the County '• = of the county where the property is located.
Filing Date: Form must be completed and signed by December 31 and filed with the
Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of applicant(ownerrcoltt_ c � /] .
Is applicant the sole le r equitablel owner? If o,what is his/her exact share or interest? If owned with joint tenant or tenant in common,indicate with whom.
❑Yes ❑No
Do all joint tenants or tenants in common reside on the property?
If name on record is different than that of applicant,indicate below. ❑Yes ❑No
Name of contract seller I Has applicant owned or been buying the property under recorded contract for
at least one(1)year before claiming deduction? ❑Yes ❑No
I Is f-
Address of contract seller(number and street,city,state,and ZIP code) property in question:
IA Real property ❑Mobile home(/C 6-1-1-7)
Key - 1z_�-�number/Legal description Record number I Page number
Taxing district Zg ` . —1y�—
D t
C
Does applicant reside on rope y? 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 fall Indiana real
es 0 No property]for the Over 65 Circuit Breaker Credit initially applied/or after December 31,2019.)See reverse for details.
Is the applicant 65 years o ag or more on December 31 of the year
single return;or(2)$40,000 for individuals who filed a joint return with the
individual's spouse.)See reverse for details.
Have you filed for any other dequcttons? If Yet,what deductions?
Yes ❑No }1.'Y_ .
Have you filed for deductions in aby other county? If Yes,what county?
❑Yes El No
I/We certify under penalty of perjury that the above and foregoing information is true and correct.7 ignature applicant MY ?'_iA`i I Date(mont,f��lo 1 ^(�_� (,L
/ dress of applicar n 'f �!{lt'1s --,andn ZIP - 4:-I/+ -
N \l� j ` w L LHt}V I Date(month,day, ear) ��
Signature of authorized fepres-n'Live I ^/ 0,�
(number and street,city,state,and ZIP code) 6
Address of authorized representative r-�
�� cq) I Date(month;a ye r)'^ sl z
Signature of County Auditor I[//. (`//)
FILED
DEC 5 2022
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer GIBBON COUNTY AUDITOR