HomeMy WebLinkAboutAge_Whittler ,.4 "A 4. APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
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- 11. PROPERTY TAX BENEFITS
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r' State Form 43T08(R19 J 7 25) ��
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«• Prescribed by the Department of Local Government Finance
Information contained on this document is CONFIDENTIAL pursuant to IC 6-1 1-35-9. )Cp, 7
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)
IZID‘r 65 Credit 65 Circuit Breaker Credit
Name of Applicant (owner or contract buyer) Teiepfione Number Email Address
Is Applicant the Sole Legal or Equitable Owner? If No. What is Applicant's Exact Share or Interest' tf Owned with Joint Tenant or Tenant in Common, Indicate with Whom
D‘S DNO
If Name on Record is Different than Applicant, Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property?
ElYt f El No
Name of Contract Seller Has Applicant Owned or Bought the Property Under Recorded Contract
for at l_east One(1)Year before Claiming Credd?
es ❑ No
Address of Contract Seller (number and street, pry, state, and ZIP code) Is the Property in Question
Zeal Property ❑Movie Home (IC 6-1 1-7)
Taxing Distnct Key Number/Legal Description Record Number Page Number
Did Applicant qualify for the homestead standard deducbon in the preceding year(or was applicant roamed 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 ❑-Ye,s ❑ No
preceding calendar year) and does Applicant quality 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 8 Payable plies ❑ No
Applicant's Date of Birth (month, day, year) If Filed by a SurvM g. Urimmed Spouse,What Was the Spouses Age at the Time of Death'?
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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 Caner 65 Credit, AG! \ $
may not exceed (1) $60,000 for ridrviduafs who filed a single return, (2) $70,000 for
ndMduals who filed a A wnt return, or(3)$70,000 for ndrvrduals and al others that
share ownership as joint tenants or tenants in common For the Over 65 Circuit
Breaker Credit, AG!may not exceed (1) $60,000 for indwpduals who flied a stogie
ref urn, or(2)$70,000 for ndroduaLs who filed a joint return with the n Andua$ V-.7( \ LO...4,r
_
spouse.)(Beginning with Pay 27, income amounts for the Circuit Breaker Credit are
aruxly adjusted J See reverse for details. TOTAL $
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of Applicant Date (month, day, year)
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Address of Applicant (number and street, city, state, and ZIP code)
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Signature of Authorized Representative t Date (month, day, year)
Address of Authorized Representative (number and street, city, state, and ZIP code) FILED
Signature of County Auditor Date (month. day, year)\10 ,i1.-C _ A)( \L -f\i'Dc ry\ &) • 1_9—
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DISTRIBUTION: Onginal - County Auditor, File-Stamped Copy - Taxpayer / h a. 1/Yrz` rmd)
GIBSON COUNTY AUDITOR