HomeMy WebLinkAboutAge_SchmittAPPLICATION FOR SENIOR CITIZEN
�A
PROPERTY TAX BENEFITS
State Form 43708 (R1917-25)
Prescribed by the Department of Local Government Finance
COUNTY
TOWNSHIP
YEAR
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)
dOver 65 Credit 0 Over 65 Circuit Breaker Credit
Name of Applicant (owner or contract buyer) Telephone Number
Email Address
C-)P_�,� (pi 2 ) 6d,2-09q(o
Is Applicant the 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
GYes ❑ No
If Name on Record is Different than Applicant. Indicate Below
Do All Joint Tenants a 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
Yes ❑ No
Address of Contract Seller (number and street, city, state, and Z1P code)
Is the Property in Question: P310&
Real Property ❑ Mobile Home (IC 6-1.1-7)
Taxing District Key Number / Legal Description
Record Number
Page Number
-c)3- �Cjz)
Did Applicant qualify for the hAestead standard deduction in the preceding year (or was applicant married at the time of death to
deduction for the individual's homestead property in the immediately
Yes
❑ No
a deceased spouse who qualified for a homestead standard
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?
Yes
❑ No
Applicant's Date of Birth (month, day, year)
If Filed by a Surviving, Unmarried Space, What Was the Spouse's Age at the Tire of Death?
oq ,.�y f96C
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
tiled a single return; (2) $70,000 far
\
$
may not exceed: (1) $60, 000 for individuals who
i c)( \
individuals who filed a joint return, or (3) $70,000 for individuals and aY others that
share ownership as joint tenants or tenants in common. For the Over 65 Circuit
$
Breaker Credit AGI may not exceed: (1) $60,000 for individuals who filed a ssigle
— —r
return, or (2) $70, 000 for individuals who filed a joint return with the i ctividual''s
TOTAL
$
spouse.) laeginning with Pay 27, income amounts for the Circuit Breaker Credit are
annualfy adjusted_] See reverse for details.
I/We certify under penalty of perjury that the above and foregoing information is true and correct_
Signature of Applicant
Date (month, day, year)
Address of Applicant (number and street city, state, and ZfP code)
L
Signature of Authorized Representative
ttt!l!
te (month, day, year)
co
N
O
N
Address of Authorized Representative (number and street city, state, and ZIP code) M
tat
Signature of County Auditor
Date (month, day, year) -
c
L
J--� 0
DISTRIBUTION: Original — County Auditor, File -Stamped Copy — Taxpayer