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HomeMy WebLinkAboutAge_Nivens _____,a- '4' "" APPLICATION FOR SENIOR CITIZEN �' COUNTY TOWNSHIP YEAR -at .?:1 it, PROPERTY TAX BENEFITS -c iL cky-d ,I iris, :, , --. State Form 43708(R 19/ 7-25) n�` l�Q�: fi:-S . h l iM• Prescribed by the Department of Local Government Finance CDI '+c . Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. Instructions. To be filed in person or by marl with the county auditor of the county where the property is located. Film Date: Form must be completed. signed, and hied with the county auditor or postmarked by January 15 of the calendar year in which the properly taxes are first due and payable See reverse side for additional instructions and qualifications. Type of Benefit Requested (Please check all that apply) 0Over 65 Credit ©over 65 Circuit Breaker Credit Name of Applicant (owner or contract buyer) Telephone Number Email Address ‘\ .1 a-r\ rek-- ‘ N-j. k \) e•X\_ - (-1 Ca \40- L CAL12 Is ApQitant the 1.5_Legal or Equitable Owrrer7 If No,What is Applicants Exact Share or Interest? if Owned with Joint Tenant or Tenant in Common. Indicate with Whom Erre ❑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 Claurning Credal \` 4 0 Yes El No Address of Contract Seller (number and street, city, slate, and ZIP code) Is the Property in Question. 0 Real Property ❑ Mobile Home(iC 6-1 1-7) Taxing Distract '' , Key Number/Legal Description Record Number Page Number CC �- - I1 D - n 0 o,i : . Did Applicant quart br the homestead standard deduction in the preceding year (or was applicant marred 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 ❑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? 111 Yes El 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? \ ( C . 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 may riot exceed (1) $60,000 for individuals who filed a single return, (2) $70,000 for f L S 57 L] .::. individuals who filed a joint return; or(3) S70.000 for individuals and al others that ) 1 share ownership as Joint tenants or tenants in common For the Over 65 Circuit , Breaker Credit. AGI may not exceed:(1)560,000 for individuals who filed a sngle a Li $ s� (.060 return, or(2) $70.000 for individuals who filed a pint return with the rdividtkatsc3C spouse.)[Beginrrng with Pay 27, income amounts for the Circuit Breaker Credit are annually adjusted.]See reverse for details. TOTAL $ IIWe certify under penalty of periury that the above and foregoing information is true and correct Signature of Applicant Date (month, day,year) . e /),b140.,,,Aimv 1lA9VT _ --- c Q - . Address of Applicant (number and street, city, state, and ZIP code) -.%rAl ---'i--, - 71----(k_a_i•k " __) #' - \ 0 A_Aa.(1- 6\c_j, i 11 • `--k-It.100 Signature of Authorized Representative Dale prrorttl;ary, Address of Authorized Representative (number and street, city, state, and ZIP code) Signature of County Auditor I Date (month , 4:44ED • _''''.-r.c) -- 1--\0-03' 1 - \ r)N-',.. -V ...f-?....1)._ i MAR 19 2026 DISTRIBUTION: Original - County Auditor; File-Stamped Copy - Taxpayer �1 ,-- GIBSON COUNTY AUDITOR