HomeMy WebLinkAboutAge_Hyatt ~` ""'' APPLICATION FOR SENIOR CITIZEN
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COUNTY TOWNSHIP YEAR
t— PROPERTY TAX BENEFITS
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State Form 43708 (R19 / 7-25) cp ZS , 2J '2
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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, signed, and filed with the county auditor or postmarked by January 15 of the calendar year in
which the property taxes are first due and payable.
See reverse side for additional instructions and qualifications. _
Pal Over 65 Credit Over 65 Circuit Breaker Credit
Name of Applicant (owner or contr.ct • yer) Telephone Number ail Address
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Is Applicant the Sole al or Equitable Owner? If No, What is Applicant's Exact Share or Interest? If Owned with Joint Tenant or Tenant in Common, Indicate with Whom
es ❑ No
If Name on eco Yes
Different than Applicant, Indicate Below Do All Joint Tenants or Tenants in Comm n Reside on the Property?
Yes ❑ No
Name of Contract Seller I Has Applicant Owned or Bought the Pr Under Recorded Contract
for at Least One(1)Year before Claim g 9redit?
Yes ❑ No
Address of Contract Seller (number and street, city, state, and ZIP code) Is the Property in Question:
cjiteal Property ❑ Mobile Home (IC 6-1.1-7)
Taxing District Key Number/ Legal Description Record Number Page Number
J23 , 2 - )2 -0'1--20Lk - bQS . (=> 9-- CaS ,
Did Applicant qualify for the homestead standard deduction in the preceding year (or was applicant married at the time of death to
a deceased spouse who qualified for a homestead standard deduction for the individual's homestead property in the immediately Yes ❑ No
preceding calendar year) and does Applicant qualify for the homestead standard deduction in the current year?
spouse.)[Beginning with Pay 27, income amounts for the Circuit Breaker Credit are
annually adjusted.]See reverse for details. $
I/W Fe certify under penalty of perjury that the above and foregoing information is true and correc �O
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)</SnateofAPPIicant ( \ JJCT)
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Irp?? onth, day, yea 2)7) 3.f?----- s� �Q
Address of Applicant (number and street. city, state, and ZIP code) ��C�~
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Signature of Authonzed Representat't / Date (month, day, y •
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Address of Authorized Representative (number and street, city, state, and ZIP code)
Signature of County Auditor 1 Date (m h, day, y ar)
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DISTRIBUTION: Original - County Auditor: File-Stamped Copy - Taxpayer
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