HomeMy WebLinkAboutAge_ElpersAPPLICATION FOR SENIOR CITIZEN
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PROPERTY TAX BENEFITS
fit' �p State Form 43708 (R2015-26)
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.
aED
Filing Date: Form must be completed, signed, and filed with the county auditor or postmarked by January 15 of the F
dy
which the property taxes are first due and payable.
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See reverse side for additional instructions and qualifications. AUG 14 2026
Type of Benefit Requested (Please check a fiat apply)
Over Over 65 Circuit BI key Credit
65 Credit
Name of Applicant (owner or contract buyer) Telephone Number
31717
Email Address
GIBBON COUNTY AUDITOR
Is Applicant t 6 Sole Legal or Equitable Owner? If Not, What is Applicant's Exact Share or Interest? If
Owned with Joint Tenant or Tenant in Common, Indicate with Whom
L1d"Yes ❑ No
If Name on Record is Different than Applicant, Indicate Below
Do All Joint Tenants or Tenants in Common Reside on the Property?
❑
-d 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?
12"Yes ❑ No
Address of Contract Seller (number and street, city, state, and ZIP code)
Is the Pro erty in Question:
Real Property ❑ Mobile Home (IC 6-1.1-7)
Taxing District Key Number / Legal Description
Record Number
Page Number
Does Applicant reside on the real prop rty, mobile home, or manufactured home?
Yes
El 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
R 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
�EIN
Applicant's Date of Bi In (month(day, year)
If Filed by a Surviving, Unmarried Spouse, What Was the Spouse's Age at the Time of Death?
OR 17 �;-9
Source of Income
Amount of Income
Adjusted Gross Income (AGI) of applicant, applicant and spouse, or applicant
Credit, AGI
00
and joint tenants or tenants in common, as applicable (For Over 65
filed (2) $70, 000 for
�D /0 D �i�
` V
$ [� /9
/+�
may not exceed: (1) $60,000 for individuals who a single retum;
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
AGI (1) $60, 000 for individuals who filed a single
�v ^
$ /3 `
Breaker Credit, may not exceed:
retum, or (2) $70,000 for individuals who filed a joint return with the individuaI's
spouse.) [Beginning with Pay 27, income amounts for the Circuit Breaker Credit are
TOTAL
$
annually adjusted.] See reverse for details,
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
o pplicant
Date (month, day, year)
?Adssf pplica (n be nit eat, city, state, and ZIP cod
Signature of Authorized Representative
Date ( onth, day, year)
Address of Authorized Representative (number and street, city, state, and ZIP code)
Sign ure of County Auditor IDate
(month, fay, ea
U � 1 ao,*
DISTRIBUTION: Original — County Auditor; File -Stamped Copy — Taxpayer