HomeMy WebLinkAboutAge_Lepeau APPLICATION FOR SENIOR CITIZEN COUNTY To SHIP YEAR
PROPERTY TAX BENEFITS •
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State Form 43708(R16/ 1-23) ghson -v. •
Prescribed by the Department of Local Government Finance
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
Valuation J Over 65 Circuit Breaker Credit
Name of Applicant (owner contract buyer)
Xr' /}
Y I]es No l
if Name on ecord is Different than Applicant, Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Properly
, Yes J No
Name of Contract Seller Has Applicant Owned or Bought the Property Under rded Contract for at Least
One(1)Year before Claiming Deduction? Yes J No
Address of Contract Seller (number and street, city, state, and ZIP code) Is the Property in Quest*o
eal Property Mobile Home (IC 6-1. 1-7) ,
Taxing District Key Number/Legal Description Record Number Page Number
. 2( - 13 --13 Ai02 - 001 . l C19 -00 4-
Does Applica R- on Property? Assessed value of the property as of current year assessment date (May not exceed$240,000 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[al
3 Yes ❑ No Indiana real property]for the Over 65 Circuid Breaker Credit Initiaiy a ppked for after December 31, 2019.)See reverse for details.
a.
-Is the Applicant :• Year of Age or More on December 31 of the Year Prior
(
Have You Filed for Any Other Deductions? - If Yes, What Deductions?
4Yes 0 No C-.0001
) .
Have You Filed for Deduction in Any Other County? If Yes, VVhal County? P14
❑ Yes No46:6
I/We certify under penalty of perjury that the above and foregoing information is true and correct. `C O
Signature of Appr of Qi to(month, day, ,(`
t` 1JT
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Ad of i fit (number and street, ci , ZIP code) A i ( iegZiChl f ' Si.&D
(i-- 0 / a fu -f_be 004Piglid 0' fi-Xj—Ai qt7b (-14' -'40.0- I.
Signature of AuthorizedRepresentative / Date (month, day, Alb,:
Address of Authorized Representative (number and street, city, state, and DP code)
Signature of County Auditor �J� Date (month, day, year)
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DISTRIBUTION: Original —County Auditor; File-Stamped Copy — Taxpayer (q--)
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