Age_Downey APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR '
1 PROPERTY TAX BENEFITS
S f
State Form
by (R9/9-08) ��
�n. Prescribed by the Department of Local Government Finance i I„\
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Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.1-35-9.
INSTRUCTIONS: APR 1 4 2014
To be filed in person or by mail with the CountyAuditor 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 b ective.
2) Mobile Homes assessed under IC 5-1.1-7 or manufactured homes not assessed as real property: 2)months
before March 31 of the year the deduction is to be effective. G IBSON COUNTY AUDITOR
See reverse side for additional instructions and qualifications.
Type of benefi requested(plea eck at that apply)
er 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer)
oK' ccteorl
If
Is applicant de legal or equitable No,what is his/her exa hare 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 sheet,city,state,and ZIP code) Is the property in question:
❑ Real property ❑ Mobile home(IC 6-1-1-7)
Taxin district Key number/Legal description Record number Page number
a0—.a-opt-101-00h i asoaa
Is the property used and occupied primarily for Assessed value of the properly as of March 1,current year(may not exceed$162,430
his/her residence? for Over 65 deduction,or$160,000 for the Over 65 Circuit Breaker Credit)
❑ Yes ❑ No
Was the applicant 65 years of age or more on December 31 of the year
❑ Yes ❑ No
INVe 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 .
Si natt f applicant Address of applicant (number and street,city,state,and ZIP code) - ,
1
t8?W2YiLflt4 >c Sag l) , 3 JAJ - Y7d7D
n Lure of authorized representative f Address of authorized representative (number and street,city,date,and ZIP code)