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HomeMy WebLinkAboutAge_FloydAPPLICATION FOR SENIOR CITIZEN _ PROPERTY TAX BENEFITS .,� State Form 43708 (R19 / 7-25) Prescribed by the Department of Local Government Finance Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. COUNTY TOWNSHIP YEAR 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 qualiFcations. Type of Benefit Requested (Please check all that apply) Over 65 Credit Over5 Circuit Breaker Credit Na a of Applicant (owner or contract buyer) TZ Telephone Number ( Fiz) /11PZ1 Email Address it) / Is Applicant the Sole Legal or Equitable Owner? If No, What is Applicant's Exact Share or Interest? If Owned with Joint Tenant or Tenant in Common, Indicate with Whom VEyes ❑ No If 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'. [I Yes ❑ No Address of Contract Seller (number and street, city, state, and ZiP code) Is the Property in Question: LE] Rea Property roperty ❑ Mobile Home (IC 6-1.1-7) Taxing District Key Number / Legal Description Record Number Page Number °1 /- — r Did Applica ualify for the h estead 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 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? 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 Time of Death? -7 ofir yW 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 Credr4 AGi may not exceed: (1) $60, 000 for individuals who fried a single retum, (2) $70,000 for / / e �P ZOZ `4 �j $ 30 2,� ✓ 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 Circuit Breaker Credit, AGI may not exceed: (1) $60,000 for individuals who fried a single %! f' 2©x � $ f 2, return, or (2) $70,000 for individuals who filed a joint return with the individuals O�✓ 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 cant Date (month, day, year) Addre Applicant (number and stree state, and OP code) '7d�D5 Sri DD V��'� N Signature of Authorized Representative Date (month, day, year) cv Q37 Address of Authorized Representative (number and street, city, state, and ZIP code) Q Signature of County Auditor Date (month, day, year) J 0 DISTRIBUTION: Original — County Auditor, File -Stamped Copy — Taxpayer