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Home My WebLink AboutAge_Graham s -- 1 \.,Ne---c / P - 9dojNa . - ,,, Arid. APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP , YEAR . l,, PROPERTY TAX BENEFITS PA \,. �/ State Form 43708(R19Ze 1. rescbed by the Depant 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 allthat apply) ^ Over 65 Credit ©-Over 65 Circuit Breaker Credit Name of Applicant(owner or contract buyer) Telephone Number Email Address --1.00\4 i P)c- -el C (/-OtiNASII ( siD a L-C3 -. Cf- 07 , —___ _ Is Applioathe 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 1:16---AS ❑No If Name on Record is Different than Applicant, Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property? 0-Yes ❑ No Name of Contract Seller Has Applicant Owned or Bought the Property Under Recorded Contract for at Least One(1)Year before Claiming 9 es El No Address of Contract Seller (number and street, city, state, and ZIP code) Is the in Question eel Property ❑ Mobile Home (IC 6-1 1-7) Taxing District Key Number/Legal Descnption Record Number Page Number --- -7 e_P c -- \ q- R - ° -(0am . lao - c 4) Did Applicant quality 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 property in the immediately Q 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? ❑v YeS 0 No Applicant's Date of Birth (rnont , day,year) If Fled by a Surviving.Unnamed Spouse.What Was the Spouse's Age at the Tone of Death? 1-- VoQ - PI - lC) 1g Lo 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.___. . $ may not exceed- (1) $60,000 for individuals who filed a single return; (2)S70,000 for ao i dividuals who hled a joint return;or(3)$70.000 for individuals and a/others that share ownership as joint tenants or tenants in common For the Over 65 Crime Breaker Credit, AGI may not exceed (1)S60,000 for individuals who fired a single1.....\92c) return, or(2)$70,000 for individuals who filed a form return with the ndividuafs Q Ig H . spouse_)[Beginning wth Pay 27, income amounts for the Circuit Breaker Credt are annually adjusted.]See reverse for details. TOTAL S I/We certify under penalty of perjury that the above and foregoing information is true and correct. Signature of Applicant /�' Date (month,\day, year) '1---6- ---trt---1,--'-,- X a/271* D Address of ApEcant (number and treet, city, state, and ZIP ) c ) u - kit Qq2 Signature of Authorized Representative (month, ` r i9 epr � Date flay, year) Address of Authorized Representative (number and street, city, state, and ZIP code) IF V Signature of County Auditor _ Date (month. day, year) \ ‘- ‘1N 534- --C)(-4- `V __DI--iC\Lj. ) fIC3 CM , --,---) - \ -- Fi5i44) 2026 ..___e-' DISTRIBUTION: Original - County Auditor, File-Stamped Copy - Taxpayer / )-2 /-a. . rZ`, RR U GIBSON COUNTY AUDITOR