HomeMy WebLinkAboutAge_Oursler i4.7R,r.4 APPLICATION FOR SENIOR CITIZEN MEN= TOWNSHIP YEAR
d' '='- a PROPERTY TAX BENEFITS
x State Form 43708 (R15 / 1-20)
Prescribed by the Department of Local Government Finance S 4 ___O� S �� `�22
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Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. ( 4 -1-(2-a
1-4
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INSTRUCTIONS: To be filed in person or by mail with the County Auditor of the county where the property is located. ` E��O
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Filing Date: Form must be completed and signed by December 31 and filed with the county auditor or postmarked by the following - -- — "-
January 5 of the calendar year in which the property faxes are first due and payable.
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See reverse side for additional instructions and qualifications. ?\\.n „3,\2__ __ Li r- ..___-
Type of benefit requested (Please check all that
( l Ove 65 Deduction fro Assessed Valuation n Over 65 Cieili -Atl . ca,,,\ , . rcuit Breaker Credit
Name of applicant (owner or contract buy r) ��
Is Applicant the sole legal or equitable ow r? If No, his!he.r exact share or intlrest? If owned with joint tenant or tenant in common, indicate with whom.
❑Yes n No
I If name on record is different than that of applicant, indicate below. I Do all joint tenants or tenants in common reside on the prbperty?
❑Yes ❑No
Name of contract seller Has applicant owned or been buying the property under recorded contract for
at least one (1) year before claiming deduction?
nYes n No
Address of contract seller (number and street, city, state, and ZiP code) is property in question-
Real property C Mobile home (iC 6-1-1-7)
Taxing district Key umber / Legal description Record number Page number
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Does applicant reside on pr rty? Assessed value of the property as of current year assessment date (May not exceed$200,000 for Over 65 Deduction or$199,999
Yes (—] N p (counting just the homestead site]for the Over 65 Circuit Breaker Credit received before January 1, 2020. and$199,999[all Indiana real
property]for the Over 65 Circuit Breaker Credit initially applied for after December 31, 2019.) See reverse for details.
I: )plicant 65 years ag or more on December 31 of the year Appli ant's gate of birth (month. day. ear) If filed by a surviving, unmarried spouse, what was
p he year taxes ar first d and payable' 4 ' 1 T
(�Yes [�No — v Ci he spouse's age at the time of death?
Adjusted Gross Income (AGI) of applicant, applicant and spouse, or appli ant 1 ) So rce of Income Amount of Income
and joint tenants or tenants in common, as applicable (For Over 65 Deduction, -- -
AG! may not exceed. (1) $30,000 for individuals who filed a single return; (2) 2.O Z� _ $ t 'E), c-
$40,000 for individuals who filed a joint return; or(3) S40,000 for individuals and all
others that share ownership as joint tenants or tenants in common. For the Over 65 Q e a Circuit Breaker Credit, AGI may not exceed: (1) $30,000 for individuals who filed a ' $ ri ��
single return; or(2) $40,000 for individuals who filed a joint return with the
individuals spouse.) See reve a for details. TOTAL $
Have you filed for any other dedu ns? If Yes, w u bons?
•e s (� N o FILE±)
Have you filed for deductions any ther c u y? If Yes, what c nty°
Yes o
Me certify under penalty of perj th t the above and foregoing information is true and correct. 2 7 2023
Si nature of applicant j Date (month, day, year)
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dress applicant (number and street, city. state, and ZiP code) . i + `
bto
�c�taL OUNTY AUDITOR
GIBSON C
Signature of authorized representative Date (month, day, year)
Address of authorized representative (number and street, city, state, and ZIP code)
Signature of County Auditor \..6 Date (moth, day. year)
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