HomeMy WebLinkAboutAge_Moy 7.-_=`f,A , � APPLICATION FOR SENIOR CITIZEN ►
4 t COUNTY TOWNSHIP YEAR
lr - PROPERTY TAX BENEFITS (1 1 30 b()11 State Form 43708(R19/ 7-25)
'"• Prescribed by the Department of Local Government Finance C)i4 Z
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.
Type of Benefit Requested (Please check all that apply)
ver 65 Credit ErOCer 65 Circuit Breaker Credit
Name Applicant (owner or contract buyer)
L-Er\-e-; ❑ No
If Name on Record is Different than Applicant, Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property?
.-0 Yes ❑ No
Name of Contract Seller Has Applicant Owned or Bought the Property Under Recorded Contract
for at Least One(1)Year before Claiming Credit?
Ij es ❑ No
Address of Contract Seller (number and street, city, state, and ZIP code) Is the Property in Question:
LE Real Property ❑ Mobile Home (IC 6-1.1-7)
Taxing District Key Number/ Legal Description Record Number Page Number
P‘ ,) tkrCe_ t z 6 - 12-010 - 3o3 --coZ-31/ --D2 g -
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 Ees ❑ 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 ❑ No
Applicant's Date of Birth (month, day, year) If Filed by a Surviving, Unmarried Spouse,What Was the Spouse's Age at the Time of Death?
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i/We certify under penalty of perjury that the above and foregoing information is true and correct.
ignature of Applicant Date (month, day, year)
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Address of Applicant number and , city. state, and ZIPode) (17:4 ,i .
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Signature of Authorized Representative Date (month, day, year) 1 ON
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Address of Authorized Representative (number and street, city, state, and ZIP code) ; a C
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Signature of County Auditor Date (month, day, year) 11 U
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DISTRIBUTION: Original - County Auditor: File-Stamped Copy - Taxpayer 'c: