HomeMy WebLinkAboutAge_McClellanAPPLICATION FOR SENIOR CITIZEN
PROPERTY TAX BENEFITS
State Form 43708 (R19 / 7-25)
Prescribed by the Department of Local Government Finance
COUNTY
TOWNSHIP
YEAR
1 ��
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)
0 Over 65 Credit 0 Over 65 Circuit Breaker Credit
Name of Applicant (owner or contract buyer)
Telephone Number
Email Address
IS Appliciiint 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
0 Yes No
If Name on Record is Different than Applicant, Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property?
Q Yes ❑ No
Name of Contract Seller Has Applicant Owned or Bought the Properly Under Recorded Contract
for at Least One (1) Year before Claiming Credit?
0 Yes No
❑
Address of Contract Seller (number and street, city, state, and ZIP code) Is the Property in Question:
Q Real Property Mobile Fbme (IC 6-1.1-7)
Taxing District Key Number / Legal Description Record Number Page Number
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 individual's homestead property in the immediately
0 Yes
No
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?
rE-]Y-:
ON.
Applicant's Date of Birth (month, day, year)
If Filed by a Surviving, Unmanned Space, What Was the Spouses Age at the Time of Death?
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Adjusted Gross Income (AGI) of applicant, applicant and spouse, or applicant
Source of Income
Amount of Income
and joint tenants or tenants in common, as applicable (For Over Credit AGI
may not exceed: (1) $60,000 forindividuals who fined a sirx�e return; (2) 2) $70,000 far
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individuals who filed a joint retum, or (3) $70,000 For individuals and am others that
share ownership as joint tenants or tenants in corrmron. For the Over 65 Circuit
Breaker Credit AGI may not exceed: (1) $60,000 for individuals who tied a single
return, or (2) $70, 000 for individuals filed
,
$
who a joint return with the rrdnridual's
spouse_) [Beginning with Pay 27, income amounts for the Circuit Breaker Credit are
annually adjusted] See reverse for details.
TOTAL
$
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature o plicant
Date (month, day, year)
Address of W10nt (number an6 street, city, state, and ZIP code)
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Signature of Authorized Representative
Date (month, day, year)
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Address of Authorized Representative (number and street, city, state, and ZIP code)
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Signature of County Auditor
Date (month, day, year) U
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DISTRIBUTION: Original — County Auditor, File -Stamped Copy — Taxpayer