HomeMy WebLinkAboutAge_Klusmeier
COUNTY TOWNSHIP YEAR
rag' . - %'1) PROPERTY TAX BENEFITS 1 LS 0 02 \ n,�
State Form 43708 (R19/7-25) h.� ,)---
,,'-!.• Prescribed by the Department of Local Government Finance 1
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
‘
Type of Benefit Requested (Please c eck all that apply)
Over 65 Credit Over 65 Circuit Breaker Credit
Name of Applicant owner o contra b yer)
Owned with Joint Tenant or Tenant in Common, Indicate with Whom
Yes ❑ No
If Name on ecor is Different than Applicant, Indicate Below Do All Joint Tenants or Tenants in C•m +n Reside on the Property?
Ind Yes ❑ No
Name of Contract Seller Has Applicant Owned or Bought the P ...,rty Under Recorded Contract
for at Least One (1)Year before Claimi redit?
Yes ❑ No
Address of Contract Seller (number and street. city, state, and ZIP code) Is the Property in Question:
Real Property ❑ Mobile Home (IC 6-1.1-7)
Taxing District Key Number/ Legal Description Record Number Page Number
On 26-\1 -OL\ -LtOa-Oo1,6T-8 -0LI .
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 Prior to the Year Taxes are First Due& Payable? Yes ❑ No
$
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of Applicant Date ( onth, d y, year)
Ad s of pplic nL (number and street, city, state, and ZIP code)
.5 U .) _ Ye-- \(;. -- a' 14;)le -N) -- 1--1 -( () CA 15 7--'02____ "--
\Pill
Signature of Authorized Representative i Date (month, day, yet D
V 1...1.1411000.14
Z
0
Address of Authorized Representative (number and street, city, state, and ZIP code) 0 _....
Z c-n
till
(C4\
Signature of County Auditor 9 Date (month, day,.year
IC.)
•
\13(X/\ 01 1 '.... .
13
DISTRIBUTION: Original — County Auditor; File-Stamped Copy — Taxpayer