HomeMy WebLinkAboutAge_Runau ) _____ ( C
d,M` " 4, APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
• ‘ PROPERTY TAX BENEFITS
1. State Form 43708 (R19 / 7-25) �' 2_C
**W" ,ems, _ I 00'mu 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 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)
E Over 65 Credit likve; 65 Circuit Breaker Credit
Name of Applicant (owner or contract buyer) Telephone Number Email Address
01.1-r.e-J r"-- \A("lc:INA • ( 9p )
. _,r,:xo__.:_._ a,
_ ____ _ _,
Is Applicant the Sole Legal or Equitable Owner? If No. What is Applicant's Exac Share or Interest? If Owned with Joint Tenant or Tenant in Common, Indicate with Whom
at; ❑ No 1
if Name on Record is Different than Applicant, Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property?
❑ No
Name of Contract Seller Has Applicant Owned or Bought the Property Under Recorded Contract
for at Least One(1)Year before Claiming Credi
es ❑ No
Address of Contract Seller (number and street, city, state. and ZIP code) Is the Pro erty in Question.
Real Property ❑ Mobile Home (/C 6-1.1-7)
Taxing District Key Number / Legal Description Record Number 1 Page Number
C.,. 1
Did Applicant qualify for the homestead standard deduction in the preceding year (or was applicant married at the time of death to
.74
a deceased spouse who qualified for a homestead standard deduction for the individuals homestead property in the immediately es ❑ No
preceding calendar year) and does Applicant qualify for the homestead standard deduction in the current year?
Prior to the Year Taxes are First Due & Payable/ 1 Ye. El No
Is the Applicant 65 Years of Age or More on December 31 of the Year P
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'
1 .... \, ,„,ISLk V .
Source of Income Amount of Income
Adjusted Gross Income (AGI) of applicant., applicant and spouse, or applicant -- --
and joint tenants or tenants in common, as applicable (For Over 65 Credit, AG! $
may not exceed. (1) $60,000 for individuals who filed a single return, (2) $70,000 for a
individuals who filed a joint return:or(3) $70.000 for individuals and all others that .110 —
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 singlef.
C:\return, or(2) $70,000 for individuals who filed a joint return with the rndrvrdual'sC3-
— — -
spouse.)[Beginning with Pay 27, income amounts for the Circuit Breaker Credit are
annually adjusted]See reverse for details. TOTAL $
IIWe certify unde :a alty of perjury that the above and foregoing information is true and correct.
Signature • .ppli . t Date (month, day. year)
A. — cn _ 10 -
A eirrc of umbe and street, city, state, and ZIP code) -
j' •
Signature of Authorized Representative Date (month. day, year) e
q -1 LO 2_
Address of Authorized Representative (number and street, city, state. and ZIP code)
_FILED _ ,
Signature of County Auditor Date (month. day, year 1
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l'Y\ PS-'' ' a ---\o -a t.Q.
F. El) 10 2026
DISTRIBUTION: Original - County Auditor: File-Stamped Copy - Taxpayer
(72-2,..az,z4e' a. Pirati.\11-
GIBSON COUNTY AUDITOR