HomeMy WebLinkAboutAge_Coleman (2) 6r14 v, 17 ) .
,„:„ APPLICATION FOR SENIOR CITIZEN
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4. PROPERTY TAX BENEFITS /..
�; ' State Form 43708 (R 19/ 7-25)
'�1! Prescribed by the Department of Local Government Finance Or) 2
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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)
❑✓ Over 65 Credit p Over 65 Circuit Breaker Credit
Name of Applicant (owner or contract buyer) Telephone Number ,r Erri?il Address
Lauretta F. Coleman ( 812 ) 385-6961 (Jaymie Almon)
Is Applicant the Sole Legal or Equitable Owner? If No, What is Applicant's Exact Share or Interest? If Owned with Joint Tenant or Tenant in Common, Indicate with Whom
❑✓ Yes ❑No
If Name on Record is Different than Applicant, Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property?
✓❑ Yes ❑ No
Name of Contract Seller Has Applicant Owned or Bought the Properly Under Recorded Contract
for at Least One(1)Year before Claiming Credit?
❑✓ 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
Montgomery Twnsp 26-17-20-100-000.288-021
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 E 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? ElYes ❑ 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?
07-03-1932
Source of Income Amount of Income
Adjusted Gross Income (AGI)of applicant, applicant and spouse, or applicant -and joint tenanorts tenants in common, as applicable (For Over Credit, AGI 2024 AGI $ 46 869
maynot exceed:(1) $60,000 for individuals who filed a single return; (2) $70,000 for
individuals who fried a joint return;or(3) $70,000 for individuals and all others that
share ownership as joint fenarits or tenants in common. For the Over 65 Cirr;uit 2025 AGI 5 0 5 4 9
Breaker Credit, AGI may not exceed: (1) $60,000 for individuals who filed a single $
return.or(2) $70,000 for indiv►duals who filed a pint return with the individual's }
spouse.)[Beginning with Pay 27, income amounts for the Circuit Breaker Credit are
annually adjusted.]See reverse for details. TOTAL S
IIWe certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of Applicant Date (month, day, year)
Za„^„� 03/09/2026
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Address of Applicant (number and street, city, state, and ZIP code) 412.
111392 W 800 S, Owensville, IN 47665 a(:: c_c, o
Signature of Authorized Representative Date (month, day, year) LI
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Address of Authorized Representative (number and street, city, state, and ZIP code) n
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Signatyreof county Auditor ø )L/ci
1 Date (month, day, year) [ T
� A / 03/09/206F.f
DISTRIBUTION: Original - County Auditor; File-Stamped Copy — Taxpayer