HomeMy WebLinkAboutAge_Sauer -#` f"`"4 APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
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PROPERTY TAX BENEFITS
State Form 43708(R19/ 7-25) CC .t n -BGIC‘tOV\.
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Prescnbed by the Department of Local Government Finance
Information contained to 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) -�
EilO er 65 Credit aOver 65 Circuit Breaker Credit
Name of Applicant (owner or contract buyer) Tel_Thone Number Email Address
rtke-A PQ . • • ,
Is Apple Sole Legal or Equitable Owner' If No. What is Applicants Exact Share or Interest'? If Owned with Joint Tenant or Tenant in Common, Indicate with Whom
LRTes El No
if Name on Record is Different than Applicant, Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property?
� J O No
Name of Contract Seller Has Applicant Owned cr Bought the Property Under Recorded Contract
for at Least One(1)Year before Claiming Credit?
[�-Nees El No
Address of Contract Seller (number and street, city, state, and ZIP code) Is the property in Question
El Real Property [J Mobile Horne(IC 6`1.1-7)
Taxing Distnct Key Number/Legal Description Record Number Page Number
Did Applicant qualify for 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 individuals homestead property in the immediately EfYlic ❑ 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? � No
Applicant's Date of Birth (month, day, year) If Filed by a Surviving,Unnamed Spouse,What Was the Spouse's Age at the Time of Death?
cQ ( 101L12 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. AG!
may not exceed (1)$60,000 for individuals who filed a single return, (2) $70,000 for c; $ .3 t "n ! .
individuals who filed a pint return, or(3) $70.000 fat individuals and i others that
share ownership as font tenants or tenants in common For the Over 65 Crcuit
Breaker Credit. AG!may not exceed- (1) $60,000 for individuals who filed a single - Q 3,P'",__) $ L(2
return, or(2)S70,000 fix individuals who filed a en:return with the ridnn 3l'sI
spouse.)(Beginning with Pay 27, income amounts for the Circuit Breaker Credit are
annually adjusted]See reverse for details. TOTAL S
INVe certify under penalty of perjury that the above and foregoing information is true and correct.
t of nt �rtriztac/kte (month, day, year)
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Address of Ap Icant (number and street, city, state, and ZIP )
C 1A. -7
Signature of Authorized Representative DLte (month, day, year) ti _ J
Address of Authorized Representative (number arra street, city, state, and ZIP code)
MAR 2 3 2026
Signature of County Auditor r—� Date (month, clay, year)/ qcta _
aAtqi4/724)
GIBSON COUNTY AUDITOR
DISTRIBUTION: Onginal - County Auditor, File-Stamped Copy - Taxpayer