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HomeMy WebLinkAboutAge_Hunt (3)APPLICATION FOR SENIOR CITIZEN �d PROPERTY TAX BENEFITS d .y State Form 43706 (R2015.26) Prescribed by the Department of Laval Government Finance Information contained in this document Is CONFIDENTIAL pursuant to IC 6-1.1-35-9. Instructions: To be filed In person orby mail with the county auditor of the county where the property is located. 4-J Filing Date: Form must be completed, signed, and filed with the county auditor or postmarked by January 15 of the calendar y ar n 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) --. . IV I I i I.1C Wer 65 Credit ver 65 Circuit Breaker Credit Name of Appli t r nbact buyer) Telephone Number 131q Iuo Email Address - Is Applicant Wale at or Equitable Owner? I/ No, What Is Applicant's Exact Share or Interest? IT Owned with Joint Tenant or Tenant In Common, Indicate with Whom es ❑ No 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 ED-yes ❑ No Has AppTicam Owned or Bought the Property Under Recorded Contract !Drat Least One (1) Year before Claininfg�Cr�edir- Address of Contract Seiler (number and street, city, state, and ZIP code ) E ' eS ❑ No Is the Property In Question: Taxing District'Jd Key Number / Legal Desciription R/eel Property ❑ Mobile Home (IC 6.1.1-7) a�12-13•L3 -K©a ceo. a-l"l-OC-. Record Number Page Number Does Applicant reside on Ne 1 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 eg El Preceding calendar year) and does Applicant qualify for the homestead standard deduction in the current year? No Is the Applicant 65 Yom of Age or More an December 31 of the Year Prior to the Year Taxes are Fist Due & Payable? ❑ B ❑ No Applicant's Date of Birth (month, day, year) If Filed by a SurvMrig, Unmarried Spouse, What Was the Spouse's Age at the Time of Death? aoti� -�-a - LA LA Adjusted Gross Income (AGI) of applicant applicant andspouse, or Source of Income Amount of Income and joint tenants or tenants in common, as applicable (FOver 65 Crete, AGI may not exceed: (1) $60,000 for individuals who tied single return; (2) $70,000 for Individuals who filed ajolnt return; or $70,000 for individuals $ and BY others that share ownership as joint tenants ortenants in common. Forthe Over (55Circutt Breaker Credit AGl may not exceed. (1) $60,000 forlydividuals who filed a sfng/e mtum; or (2) $70,000 for Individuals who filed a joint return the Individuals;spouse.) $ `� with ISeginning, Pay with 27, income amounts for the Circuit Breaker (.mart are annua/lyadjusted.] See reverse for details. TOTAL $ IMe certify under penalty of perjury that the above and foregoing Information Is true nd cc Signature of pll at ate (month, day, year) X �0 OMdr o ApplImm:(numberandsheet,c/ty�state,�a}nd ZIP It ^ - Signature of Authorized Representative Dete ( ,day, of Authorized Representative (number and street, dty, state, and ZIP code) OCT 2 2 2026 Signature of County Auditor Date (month, day, year) , DISTRIBUTION: Original -County Auditor,,FileStampedCopy -Taxp yet GIBSONCOLINTYALIDITOR