HomeMy WebLinkAboutAge_MiskellAPPLICATION FOR SENIOR CITIZEN
I = PROPERTY TAX BENEFITS
i, State Form 43708 (R20 / 5-26)
°iB• 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 65 Credit Ld Over 65 Circuit Breaker Credit
Name of Applicant (owner or contract buyer) Telephone Number Email Address
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Is Applicant the Sole Legal or Equit le wne? If No, What is Applicant's Exact Share or Interest? If Owned with Joint Tenant or Tenant in Common, Indicate with Whom
Wly'es ❑ No
If Name on Record is Different than Applicant, Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property?
2-yes El No Name of Contract Seller
Has Applicant Owned or Bought the Property Under Recorded Contract
for at Least One (1) Year before ClaimingC�redi_
uvres ❑ No
Address of Contract Seller (number and street, city, state, and ZIP code) Is Property in Question:
,the
l eal Property ❑
_- Mobile Home (IC 6-1.1-7)
Taxing District Key Number / Legal Descri ton Record Number Page Number
Does Applicant reside on the real property, mobile home, or manufactured home? Yes ❑ No
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
preceding calendar year) and does Applicant qualify for the homestead standard deduction in the current year? El No
Is the Applicant 65 Years of Age or More on December 31 of the Year Prior to the Year Taxes are First Due & Payable? es ❑ 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?
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 65 Credit, AGI
may not exceed. (1) $60, 000 for individuals who filed a single return; (2) $70, 000 for
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, AGl may not exceed: $60, 000 for individuals who filed a single
return; or (2) $70,000 for individuals whoho filed a joint return with the individua!'s
c
$ 1
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.
Si gnatur of Applicant Date (month, day, year)
Address of Appli nt (number and street, city, state, and ZIP code)
Signature of Authorized Representative Date (month, d e r)
V
Address of Authorized Representative (number and street, city, state, and ZIP code)
Signature of County Auditor
(month, day, year J
DISTRIBUTION: Original — County Auditor; File -Stamped Copy — Taxpayer