HomeMy WebLinkAboutAge_GoodsonAPPLICATION FOR SENIOR CITIZEN
PROPERTY TAX BENEFITS
State Form 43708 (R1917-25)
Prescribed by the Department of Local Government Finance
COUNTY
TOWNSHIP
YEAR
K
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1A-35-9. F11,
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 willi the. county auditor or postmarked by January 15 of the calendar year in
which the property taxes are first due and payable. MAY 0 1*
See reverse side for additional instructions and qualifications. ���UC
Type of Benefit Requested (Please check all that apply)
0 Over 65 Credit nOver65Circuit�aty
me of Appli n (owner or, co tract buyer)
'RAC7`* (�';��-1�)6t/_/
Tel ho a Number
Email Address DITQ R
Is Applicant`the Sole Legal or Equltable Owner?
If No, What Is Applicant's Exact Share or Interest?
If Owned with Joint Tenant or Tenant In Common, Indicate with Whom
Dyes ❑ No
If Name on Record Is Different than Applicant, Indicate Below
Do All Joint Tenants or Tenants in Common Reside on the Property?
U.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?
Yes ❑ No
Is the Property in Question:
Address of Corl"ct Seller (number and street, city, state, and ZIP code) a
,•—vv`� — �, . —
%`• Real Property ❑ Mobile Home (iC 6-1.1-7)
Taxing Is '�ct
AM)6MAJ
Key Number / Legal Description
9R.
Record Number
Page Number
—
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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
deceased for homestead deduction for the Individual's homestead in the immediately
❑ Yes
❑ No
a spouse who qualified a standard property
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 Fled by a Surviving, Unmarried Spouse, What Was the spouse's Age at the Time of Death?
Source of Income
Amount of Income
Adjusted Gross Income (AGI) of applicant, applicant and spouse, or applicant
and joint tenants or tenants fir common, as aphid applicable (For Over65 Credit, AGi
may not exceed: (1) $60, 000 for individuals who filed a single return; (2) $70,000 far
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$ � f+l `
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individuals who filed a joint return; or (3) $70,000 for individuals and all others that
share ownership as joint tenants or tenants in common. For the Over 65 Ckwit
Breaker Credit, AGi may not exceed: (1) $60,000 for individuals who filed a single
/�7
return; or (2) $70,000 for individuals who filed a joint retum with the individual's
spouse.) (Beginning with Pay 27, income amounts for the Circuit Breaker Credit are
annually adjusted.) See reverse for details.
TOTAL
$
Wife certify under penalty of perjury that the above and foregoing information is true and correct -
Signature of Applicant t j
Date (month, day, year,
Ad Tess o pllcan umberand stre t city, state, a6d.KJP code)
Signature of Authorized Representative
Date (month, day, year)
Address of Authorized Representative (number and street city, state, and ZIP code)
i
Signa re f-Cou�n1t�y A�udiitorp� Date (month, aay, `year)
J / 0
DISTRIBUTION: Original — County Auditor, File -Stamped Copy — Taxpayer