HomeMy WebLinkAboutAge_Miller '-_'74- APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
R NPROPERTY TAX BENEFITS i`
State Form 43708(R19/7-25) CI <�,-� C9 2 �• �-Q) 2tu
•."6--f 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 properly 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 P 1 1.2 r 6 :: \ \ 2_ \ .
Type of Benefit Requested (Please check all that apply)
0 Over 65 Credit Over 65 Circuit Breaker Credit
Name of Applicant owner or contr er) Telephone Number E ii Address
\\
Is Applicant Legal quitable Owneii If No. What is Applicant's Exact Share or Interest'? If Owned with Joint Tenant or Tenant in Common, Indicate with Whom
Yes O No
If Name on �i'ec d is Different than Applicant. Indicate Below Do All Joint Tenants or Tenants in C.• •n Reside on the Property?
11 es ❑No
Name of Contract Seller Has Applicant Owned or Bought the = ••: . •- Recorded Contract
fat at Least One(1)Year before *.• , • . ••
VI Yes ❑ No
Address of Contract Seller (number and street, city, state, and ZIP code) is the = • • in Question.
W Real Property ❑ Mob de Home(E 6-1.1-7)
Taxing Distnct Key Number!Legal Description Record Nunilr•r Page Number
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 '1 Yes 0 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'? 0 Yes 0 No
Ap7S Date of Birth (moth, day, year) �7 If Flied by a Surviving, Urrnarned Spore. - as •i- Spouse's Age at the Tine of Death?
O � � 1 1 2 i
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, AGI C S
may not exceed:(1)$60,000 for individuals who filed a single return, (2) $70,000 for .. .
ndividuals who filed a joint return,or(3)$70.000 for individuals and al others that
share ownership as joint tenants or tenants in common For the Over 65 Craigl
rrw .
Breaker Credit. AGI may not exceed. (1)$60,000 for individuals who filed a single " / 24 S
return, or(2)$70,000 for individuals who filed a Pail return with the ndrvrduars
spouse.)[Beginning with Pay 27, income amounts for the Circuit Breaker Credit are
annually adjusted.)See reverse for details. TOTAL S
I/V1le certify under penalty of perjury that the above and foregoing information is true and correct. Pi/
X fiiiiiiliikure of Applican .� r Da1e (month, day, year)
4
‘t, o of Ap•licant (number and street, city, state, and ZIP code) �� J
. V't c..)3 .____ _,kruki), e i -\.Th/- ,___,_ ‘(\
Signature of Authorised Representative / Date )
N CouC2
Address of Authorized Representative (number and street, city, state, and ZIP code) 4'Z',q�
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Signature o unty Audi r Date (month, y, ar) 6
1 1/1__ g\ I ,
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DISTRIBUTION: Onginal - County Auditor; File-Stamped Copy - Taxpayer