HomeMy WebLinkAboutAge_Dunn ,4 `T"4� APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
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, PROPERTY TAX BENEFITS
State Form 43708(R19/ 7-25)
• Ce) 'lb� Y-rar\ci6.coc)N,ti «.1.14 •� _Prescribed t>y the Department 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 all that apply)
[ Over 65 Credit 65 Circuit Breaker Credit
Name of Applicant (owner or contract buyer) Telephone Number Erna Address
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is AppY nt•the Sole Legal or Equrtfible Owner? If No, What is Applicants Exact Share or interest? If Owned with Joint Tenant or Tenant in Common, Indicate with Whom
DNO
It 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 Property Under Recorded Contract
for at Least One(1)Year before Claiming Credit?_.
1 Pt" ®Yes ❑ No
Address of Contract Seller (number and street, city, state, and ZiP code) Is the Property in Question
_ eal Property ❑ Mobile Home (IC 6-1 1-7)
Taxing Distnct Key Number /Legal Descnption Record Number Page Number
ST: r OL.1- 0_, C.,0 aL0 - \ ?_--) - ( - -Dci)- coo c--ici -00L--
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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 ►ndividual's homestead property in the immediately1:1--Yg ❑ No
preceding calendar year) and does Applicant qualify for the homestead standard deduction ii the current year?
Is the Applicant G5 Years of Age or More on December 31 of the Year Prior to the Year Taxes are First Due& Payable? Q Yes ❑ No
Applicant's Date of Birth (month, day, year) If Filed by a Surviving,Unmarried Spouse.What Was the Spouse's Age at the Tine of Death?
— 1-k q i LACI - t`-'\ - q 1 .1.' ( i ,
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! $ ,2-r--1 �
may not exceed (1) $60,000 for amdn duals who fled a single return, (2) 570,000 for Ci Q L4
ndmduals who filed a joint return, or(3) $70,000 for individuals
d ai others that
share ownership as pa tenants or tenants in common For the Over 65 Grail
Breaker Credit, AG!may not exceed (1)$60,000 for rrxirviduals who fled a singe a o DI $ LA s 3 ,3
return, or(2)$70,000 for ind viduals who fled a loin!retun with the ndwiduats 4 - -
spouse.)[Beginning with Pay 27, ncorme amounts for the Circuit Breaker Credit are
annually adjusted.]See reverse for details. TOTAL $ - -
L'We certify under penalty of penury that the above and foregoing information is true and correct
Signat of Applicant Date (month, day, year)
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Address q Applicant (number and street, city, state, and ZI code)
SC L a n _r1 c_i C , JA\.) - LA—1 -)2 k--k- TILED
Signature of Authorized Representative i Date (month. day, year)
Address of Authorized Representative (number and street, city, state, and ZIP code) MAR 3 0 2026
Signature of County Auditor Date (month, day, year)L:0_V-1Q1, a _Q (i • JDCO- V.:til\_L)/( sLi_ - /� 'L
GIB AUDITOR
DISTRIBUTION: Onginal -- County Auditor, File-Stamped Copy -- TaxpayerV.)\