HomeMy WebLinkAboutAge_Barnett 0 Pu"' APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
`1 PROPERTY TAX BENEFITS
S - State Form 43168(R9 I 9-08)
' . '
rescribed by the Department of Local Government Finance
File Mark
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and 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 Dates: 1) Real Property:During the twelve(12)months before December 31 of the year the deduction is to be elfectina S ZU13
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as real property:During to ( )months
before March 31 of the year the deduction is to be effective.
See reverse side for additional instructions and qualifications.
Type of beneft requested(please check a0 that apply) COUNTY AUDITOR
GIBBON
❑ Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of applicannntt((�o(wnneerr or/cont�rracctt buyer) �/{�///� �� ��� A l ble Is applicant the sole legal or equity eft tf No,what is his/her exact or interest? If owned with someone other than spouse,
indicate with whom
Yes ❑ No
If name on record is different than that of applicant indicate below
Name of contract seller(applicant must have been buying on contract at least one(1)year)
Address of contract seller(number and street city,state,and ZIP code) Is the property in question:
❑ Real property ❑ Mobile home(IC 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
a -0-2-s9 -034-000. OR ,-0l
Is the property used and occupied primarily for
❑ Yes ❑ No
I/We certify under penalty of perjury that 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 .
Signatu applicant s Address of applicant (number and street,city,state,and ZIP code)
- , code) - .. -
AO -' ' GZ
.ignature of authorized :presentative Address of authorized representative (number and street city,state,and ZIP code)