HomeMy WebLinkAboutAge_BoyerAPPLICATION FOR SENIOR CITIZEN
L► PROPERTY TAX BENEFITS
;A State Form 43708 (R20 / 5-26)
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)
Over �ver 65 Circuit Breaker Credit
65 Credit
r Email Address
Name of Applicant (owner or contract br:m
fit\ a l�
Joint Tenant Tenant in Common, Indicate with Whom
Is Applica t Legal r itable Owner? If No, What is Applicant's Exact Share or Interest?
If Owned with or
�So/le
M Yes ❑ No
If Name on Record is Different than Applicant, Indicate Below
Do All Joint Tenants or Tenants in Common Reside on the Property?
Vly-es El No
Has Applicant Owned or Bought the Property Under Recorded Contract
Name of Contract Seller
for at Least One (1) Year before Claiming Credit
es ❑ No
Address of Contract Seller (number and street, city, state, and ZIP code) Is the Property in Question:
r
C:x2eal Property ❑Mobile Home (IC 6-1.1-7)
District Key / Legal Descrrription
Page NumberElNo
INu�mber
j1 r, ;Re;dNumber
Taxing
Does Applicant reside on the real property, mobile home, or manufactured home?
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 P,4, ❑ No
receding calendar year) and does Applicant qualify for the homestead standard deduction in the current year?
65 Years of Age or More on December 31 of the Year Prior to the Year Taxes
are First Due & Payable?
es
❑ No
FApplirant'so of Birt (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 in common, as applicable (For Over 65 Credit, AGI
filed single return; (2) $70,000 for
$
may not exceed: (1) $60,000 for individuals who a
filed a joint return; or (3) $70,000 forindividuals and all others that
individuals who
share ownership as joint tenants or tenants in common. For the Over 65 Circuit
AGI exceed: (1) $60,000 for individuals who filed a single
$
Breaker Credit, may not
retum; or (2) $70, 000 for individuals who filed a joint return with the individual's
d `
spouse.) [Beginning with Pay 27, income amounts for the Circuit Breaker Credit are
TOTAL
$
annually adjusted.] See reverse for details.
is true and correct.
I/We certify under penalty of perjury that the above and foregoing information
Signature of Applicant Date (month, day, year)
� 1
NAAJ,dress
of Applicant (number' nd street, city, state, an /P code)
Date ( onth, day, year)
Signature of Authorized Representative I
J N
Address of Authorized Representative (number and street, city, state, and ZIP code)
Signature of County Auditor n % Date
DISTRIBUTION: Original — County Auditor; File -Stamped Copy — Taxpayer