HomeMy WebLinkAboutAge_Gordon RAC' APPLICATION FOR SENIOR CITIZEN
COUNTY TOWNSHIP YEAR
:1 PROPERTY TAX BENEFITS
State Form 43708 (R19 /7-25) S`nNI\ 2_4' 0
,...,;,:,....70_,:e.)
,f.s.,, Prescribed by the Department of Local Government Finance 0
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
Type of Benefit Requested (Please he k all that apply)
Over 65 Credit ver 65 Circuit Breaker Credit
\\ Name of Applicant (owner or contr t uyer) Telephone Number it Address
- \ \`i' \ fl c> $( 10,(63.1) ( )
Is Applicant the Sole L al or Equitabl caner? : If No, What is Applicant's Exact Share or Interest? If Owned with Joint Tenant or Tenant in Common, Indicate with Whom
oLj ❑Yes No
\� . If Name on Record is Different than Applicant, Indicate Below Do All Joint Tenants or Tenants in Common-Reside on the Property?
�.�' Yes ❑ No
VName of Contract Seller Has Applicant Owned or Bought the Prope Under Recorded Contract
for at Least One(1)Year before Claimi relit?
Yes ❑ No
Address of Contract Seller (number and street, city, state, and ZIP code) Is the Property in Question:
6 Real Property El Mobile Home (iC 6-1.1-7)
Taxing District Key Number/ Legal Description Record Number Page Number
0 2- & ' 26-- 12-07- x)2_ -o0O.980 - o .
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?
Is the Applicant 65 Years of Age or More on December 31 of the Year Pnor to the Year Taxes are First Due& Payable? Yes El No
, (return:or(2) $70,000 for individuals who filed a joint return with the individual's )
spouse.)[Beginning with Pay 27, income amounts for the Circuit Breaker Credit are
annually adjusted.)See reverse for details. TOTAL $
I/V1/e certify under penalty of perjury that the above and foregoing information is true and correct.
, Signeture,of Applicant C
Date (month. day, year)
XL/1/ ,Itil' -------' fit— -. 1)
Address of Applicant (number and street, city, state, and ZIP code) ae, .
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6
Signature of Authorized Representative Date �of day, year) e�?5`
%So
Address of Authorized Representative (number and street. city, state, and ZiP code) 0 ,j�-
--)Signature of County Auditor Date ( onth, da year) 0,9
M-1011-1)(S - ••k- _) \° c2)& le:
DISTRIBUTION: Original - County Auditor; File-Stamped Copy - Taxpayer