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Home My WebLink AboutAge_FauquherAPPLICATION FOR SENIOR CITIZEN PROPERTY TAX BENEFITS eye State Form 43708 (R20 / 5-26) 'e10 Prescribed by the Department of Local Government Finance COUNTY TOWNSHIP YEAR ©t \ 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) 2-Over 65 Credit Kxn„ , as no...,.:, o Name of Applicant (owner or contract buyer) `—' —.— — —,-1V.2AVI %AUUIE er Y) Telephone Number Email Address / Is Applicant the Sole Legal or Eq ble Owner? If No, What is Applicant's Exact Share or Interest? If Owned with Joint Tenant or Tenant in Common, Indicate With Whom C'r. Yes ElNo If Name on Record is Different than Applicant, Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property? Name of Contract Seller O Yes ❑ No Has Applicant Owned or Bought the Property Under Recorded Contract for at Least One (1) Year before Claiming Credit? Address of Contract Seller (number and street; city, state, and ZIP code2—Yes ❑ No ) Is �theProperty in Question: � 2 Ll Real Pro e Taxing District P Property ❑ Mobile Home (/C 6-1.1-7) Key Number / Legal Descripti n Record Number Page Number c) X 0- Does Applicant reside on the real property, mobile home, or manufactured home? CrYes ❑ Did Applicant qualify for the homestead standard deduction in the preceding year (or was applicant married at the time of death to No a deceased spouse who qualified for a homestead standard deduction for the individual's homestead preceding calendar year) and does Applicant qualify for the homestead standard deduction in the property in the immediately ©'YeS current year? ❑ 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? [?'Yes ❑ No Applicant's Date of Birth (month, day, year) If Filed by a Surviving, Unmarred 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, AGI may not exceed., (1) $60, 000 for individuals who filed a single $ retum; or (2) $70, 000 for individuals who filed a joint return with the individual's 9 co 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. ignat r of Applicant /I Date (month, day, year) Address of Applica t (number streef, city, stat nd I code) Signature of Authorized Representative N Date (month, day, year) C"i }} � •zAddress of Authorized Representative (number and street, city, state, and ZIP code) t1 O I I l U Signature of County Auditor � Z Date (month, day, year) Gq � O9 1 �C1r�(n m DISTRIBUTION: Original — County Auditor; File -Stamped Copy — Taxpayer � APPLICATION FOR SENIOR CITIZEN (� � �nuNr,� ro asrpP rena i .,. . : PROPERTY TAX BENEFITS 1` � � '� � --', StafeFortna3708(R9/408) `� P(es�bad by Uie DeoaNmeM of local Go�emmartl Finance ,�,/7,nf1 Infortnation wntainetl in this document is CONFIDENTIAL pursuant to IC 6-1.1-�2-9 and IC 6-1.135-9. DEC 1��"eW INSTRUCT70NS: � �� To 6e filed in person or by mail wrth fhe CountyAutlitor o7 the counry where the properry is locafed. ��G � Filiry Dafes: 7J Real Property: Ounrg the tweNe (12) months be/ae December 31 of the year the deduction i��f�Q+Ql.I I�7Y AUDITOR 2) Mo6ile Hwnes assessed urMer IC 6-1J-7 ormanu7actured hwnes rrof assessed as real pmperty: Dunng fhe twehre (tt) monffis before March 31 0l fhe year t6e detluction is to 6e e%ective. See reverse siUe fa adtldiona/ instrudions erM pualifications. Typa d beneft raouested (plaase tlieck a0 Nal appyj � It name an record'u differem than ihat o( aodicar� irWicate bebw Name ot cart2p seller (applicanf must haro Doan Ouyilg d: cmtract at leasf oiro (i) yea� � MEress ot mr.tratl 5611Br (namDwaM s'veet. CrY. slalo, and ZIP todo) �s �ne omoerty in ouestion: Real pmpery � Mobile home (IC 6-14-� Tazin distnct _ I Key numbeN legal dascnotion I Record number Page r.umber ,26 -18-d1-.�Q� -DD�, a3�3 ;o�.� Is Ute OroDaM1y uSBC and occuOiBE 0��' br 0.ssessed value of ine omoerty as o( March 1, cunenl year (may nol exceetl 51B2,e30 his/ner residenw7 :or Orer 65 dodudiw:. or 5160.000 !or tho Over 65 Gircui! &eakor Credi:) �Yes ❑ No Was the aoPlicaM 65 years of ege w mwe on Oacember 31 ot the year Have you filed for eny othar detluctior:si If Yes, wnat deduc6or,s? Yes ❑ No `� S Have you fJed fw deductions in any other wunryP If Yus, what counry? � Yes ❑ No INVe certify under penalty of perjury lhal the above and foregoing information is true and correct and that the applicant was a resident of Indiana and owner of the aforementioned property on March 1, 20 Sgnature of apdKert AaEress of aoo��car.i (number and sUOet. ci,y. ifato. antl ZIP wtlej ., � D S� -S' - �/S�� '�/% � � Sgnature of auLhonzec reDresentative AdCress oi authorizeC reoaseNalive (num5orontl s✓eet. ciry, sa:e, and P code)