HomeMy WebLinkAboutAge_WorkmanAPPLICATION FOR SENIOR CITIZEN
PROPERTY TAX BENEFITS COUNTY TOWNSHIP YEAR
.,� Slate Form 43706 (R20 / 5-26) .� r /j y-7t
Prescribed by the Department of Loral Government Franca D /V P t (J ! I/!
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9.
Instructions: To be filed In person orby mall with the county auditor of the county where the property is located.
Filing Date: Form mustbecompleted, signed, and filed with the county auditor or postmarked by January 15 ofth r: IerIiat e r r D
which the property taxes are gist due and payable.
See reverse side for additional instructions and qualificatfons. Type of Benefit Requested fP/ease checrr ab rn<r n,,,,r„r OCT
I qi 909
on
Name
EI Over 65 Credit
pliant owner orcontrea bu r) Tele hone Number
✓I Jo k ! ( 8'!) ),)-15- 49'lg
t`he�, Ye Legal o Equitable owner! If No, What is Applicant's Exact 'Sham
}[J Yes ❑ No
Over 65 Ciro t reaker Credit
Email Address
GIBSON COLIN
If Owned with Joint Tenant or Tenant in I
Do All Joint Tenants or Tenants in Corn
for at Least One
Question:
t77r
bict J Key Number? Legal Dascriptloq Real Property ❑
$ %irA /PCT71 / , r - &D�Record Numbs
/CJrVtn-f(/ Gq0 //-l2- v(f rl(a0— Dab'icant reside on the real property, moblle home, or manufactured home?nt qualify for the homestead standard deduction In the recedin Yes
spouse who qualified for a homestead standard dedu lion for the nd vidual's homiestead arose ty me tl I of death to�jlendar year) end does Applicant qualify for the homestead standard deduction In the ounent yeaRrn the ImmedlalelyAYes
cant 65 Yaws of Age or More on Dscemtxar 31 of the Year Prior to the Year Texas are First Due & Payable?
Yes
Applic-ant''s�ate oIBirth (month ey, year) if Filed by a Surviving, Unmanled Spouse, What Was the Spouse
�1�slOkL-W)9 �Srel�f!%UIJo,�
Adjusted Gross Income (AGI) of applicant, applicant ands spouse, crept dZ ✓
P applicarK
Source of Income
andjoint tenants ortenants in common, as applicable(Forover65 Credd,AGl
may n« exceed, (1 J $60,000 for Individuals who filed a single return; (2) $70,000 ror
individuals who Ned a Wnt
return; or (3) $70,000 for individuals and all others that
share ownership aslant tenants ortenants in
common. Forthe Over 65 Cimult
Breaker Cred% AGlmay not exceed.-(1)$60,000forindividua/s who Nedasing/e
retum,'or (2) $70,000 forindMduals
`
who filed a)amretum with the individual's
spouse.) [Beginning with Pay 27, mcorne amounts for the Circuit Breaker Credit are
!!! !! oCIJ aab
annu*adjusted] See reverse for details.
INJe certify under penalty of perjury that the above and foregoing Information is true and correct.
-----------------------
Signature of Applicant
Q Date (month, day, year)
k �zy� C/ /O !s G+�Oe Address of Appi4ca (numberend atreet, c te, and l e ' /7
Signature of(Authorized epresentadve
Data (month, day, year)
state,
c
AUDITOR
non, Indicate v
Reside on the
s ❑1
Credit?
n
❑ No
❑ No
s Age at Die mme of Des
Amount of Income
6s-, 169
$ 6-
TOTAL 1 $
DISTRIBUTION: Original - County Auditor, File -Stamped Copy -Taxpayer