HomeMy WebLinkAboutAge_Benefiel /. ` ' APPLICATION FOR SENIOR CITIZEN
COUNTY TOWNSHIP YEAR
*) PROPERTY TAX BENEFITS
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441
1 State Form 43708 (R19 17-25) GC 2 J
=e,®-/ 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. (
Type of Benefit Requested (Please the k all that apply)
Over 65 Credit Over 65 Circuit Breaker Credit
Name of Ap . nt (owner or contr t yer) Telephone Number ail Address
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Is Applicant uitable Own . If No. What is Applicants Exact Share or Interest? If Owned with Joint Tenant or Tenant in Common, Indicate with Whom
/'1 Yes ❑ No
If Name on •ec. d is Different than Applicant. Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property?
b!d Yes D No
Name of Contract Seller Has Applicant Owned or Bought the P #: y Under Recorded Contract
for at Least One(1)Year before Claims edit?
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 1 Record Number Page Number
CYo(-) J/A)J/11\p‘l Ck 0 A - O Soo - 000. 1--)06 - 006
Did Applicant qualify for the homestead standard deduction in the preceding year (or was applicant mamed at the time of death to
a deceased spouse who qualified for a homestead standard deduction for the individual's homestead properly 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? 4/Yes ❑ No
$
I/V1Je certify under penalty of perjury that the above and foregoing information is true and correct. -1k
X' Sig,ure of ca0 Date (month, day, year) liiiilk. ..
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Address of Applicant (number and street, city, state, and Zi code) /5
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Da s S ', so f o f lbnd Cily ,n- L-H-6 0 . �''es4� n r
Signature of Authorized Representative Date (morf(tr,1:- year) ' '
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Address of Authorized Representative (number and street. city, state, and ZIP code) ��
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Signature of County Auditor / `, � Date (month, d year) O'4
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DISTRIBUTION: Original — County Auditor; File-Stamped Copy — Taxpayer
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