HomeMy WebLinkAboutAge_RussellAPPLICATION FOR SENIOR CITIZEN
PROPERTY TAX BENEFITS
q State Form 43708 (R2015-26)
* 7e16 Prescribed by the Department of Local Government Finance
COUNTY
TOWNSHIP
YEAR
C:••1b
A
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 ndar a '
which the property taxes are first due and payable.
See reverse side for additional instructions and qualifications.
c
Type of Benefit Requested (Please check all that apply) Z6'
L1 Over 65 Credit c it Breaker Credit V � -
Name of Applicant (owner or contract buyer)
Tel hone Number
Email Addr ��
� iX, tiIq -11 a.
q
Is Applicant t k e_ �e Legal or Equitable Owner?
If No, What is Applicant's Exact Share or Interest?
If Owned with Joint Tenant or Common, Indicate with Whom
tJ' Yes ❑ No
If Name on Record is Different than Applicant, Indicate Below
Do All Joint Tenants or Tenants in CommonR side on the Property?
Name of Contract Seller
`Yes ❑ No
Has Applicant Owned or Bought the Property Under Recorded Contract
for at Least One (1) Year before Claiming Cre' .
'Yes ❑ No
Address of Contract Seller (number and street city state and712code) Is the Proppe in Question:
.Real Property ❑ Mobile Home (IC 6-1.1-7)
Taxing District Key Number / Legal Description Record Number Page Number
�l�- (�" �� -� - �� •n3�- oa
Does Applicant reside on the real property, mobile home, or manufactured home?
LJYes
❑ No
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
preceding calendar year) and does Applicant qualify for the homestead standard deduction in the current year?
01<ees
❑ NO
Is the Applicant 65 Years of Age or More on December 31 of the Year Prior to the Year Taxes are First Due &Payable?
Wes
❑ 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?
Adjusted Gross Income (AGI) of applicant, applicant and spouse, or applicant
Source of Income
Amount of Income
and joint tenants or tenants in common, as applicable (For Over 65 Credit, AGI
may not exceed: (1) $60,000 for individuals who filed a single return; (2) $70,000 for
individuals who filed a joint return, $70,000 for individuals
$ (-
or (3) and all others that
share ownership as joint tenants or tenants in common. For the Over 65 Circuit
Breaker Credit, AGi may not exceed., (1) $60,000 for individuals who filed a single
return, or (2) $70,000 for individuals who filed a joint return with the individual's
$ I
spouse.) [Beginning with Pay 27, income amounts for the Circuit Breaker Credit are
annually adjusted.] See reverse for details.
TOTAL
$��
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of Applicant Date (month, day, year)
a-�
Adddrr(ess of'Applicant (nu er and street, city, state, and ZIP code)
, (�
l-J-1 `/ Y ' k7 ESL O
Signature of Authorized Representative t
Date (month, day, year)
Address of Authorized Representative (number and street, city, state, and ZIP code)
Signature of County Auditor
i'—p a. � / m
Date (month, day, year)
%
- a�-aLQ
DISTRIBUTION: Original — County Auditor; File -Stamped Copy — Taxpayer
/,�
. � .
��` ""' APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
:t 4 PROPERTY TAX BENEFITS
.milk
,, State Form 43708 (R 19 /7-25) 3 '� OM
141,11 Prescnbed 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 marl 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
Type of Benefit Requested (Please check all that apply)
❑Over 65 Credit ❑ Over 65 Circuit Breaker Credit
me of Applicant (owner or contract buyer) Telephone Number Email Address
-\ -- aNA t_. S 4_0.1 . ( )
Is Applicant the L g r Equitable Owner? If No. What is Applicants Exact Share or Interest? If Owned with Joint Tenant or Tenant in Common. Indicate with Whom
Yes ❑No _ I
If Name on ecor is Different than Applicant. Indicate Below Do All Joint Tenants or Tenants in Co mon Reside on the Property?
j Yes ❑ No
Name of Contract Seller Has Applicant Owned or Bought the r..• y Under Recorded Contract
for at Least One(1)Year before Claimin• r edit?
to Yes ❑ No
Address of Contract Seller (number and street. city, state, and ZIP code) Is the Property in Question
PAI eal Property ❑ Mobile Home (IC 6-1.1-7)
Taxing District Key Number 1 Legal Description Record Number Page Number 1
_ CD1g 2C-\2- 18 2- obi . a.32 ^
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 E4 Yes El 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 Prior to the Year l axes are First Due & Payable? pi. es ❑ No
Signature of Appli>:nt Date (month, day, year)
4V4d 4 ,_ . 4 e..4�. / _ _ot , -- s ,__c1)-kdt-,s-\- JAN 1 2026
? )e\by-1, n _ ),-- --(i -to .
Address of App scant (num.-r and street. city. state. and ZIP code)
Signature of Authorized Representative Date (m )
GIBSON COUNTY AUDITOR
Address of Authorized Representative (number and street, city, state. and ZIP code)
Signature of Cou ty A ditor [oaton. 7ear)
V \\7)--e.., Co
1 1 i_. .7c°2- .
DISTRIBUTION: Original - County Auditor; File-Stamped Copy - Taxpayer