Age_Strunk rt'ry APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
•c *;t PROPERTY 2!::ment State FormFILE D
Prescribed by by the the 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. JUL 2 5 2016
INSTRUCTIONS: 5 u
To be filed in person or by mail with the County Auditor of the county where the property is located. I .541111
Filing Dates: 1) Real Property:Durin the twelve(12)months before December 31 of the year the dedu • o ;6" /Jth
9 ) During O y ur. �= b N Au I'[ R
2) Mobile Homes assessed under IC 6-7.1-7 or manufactured homes not assessed as real property:During the twee( )months
before March 31 of the year the deduction is to be effective.
See reverse side for additional instructions and qualifications.
Type of benefit requested(please check all that apply) ,,..,�
Over 65 Deduction from Assessed Valuation L,,---{{Aver 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer)
St A 57e
Is applicant the sole legal or equitable owner? If No,what is his/her exact share 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(f)year)
Address of contract seller(number and street,city,state,and ZIP code) Is the properly in question:
eal property LI Mobile home(IC 6-1-7-7)
Taxing district `Key number/Legal description Record number Page number
►a-N-3c -co \. 389-0077
Is the property used and occupied primarily for Assessed value of the property as of March 1,current year(may not exceed 5182,430
his/her residence? for Over 65 deduction,or 5160,000 for the Over 65 Circuit Breaker Credit)
c"kles ❑ No
Was the applicant 65 years of age or more on December 31 of the year
Have you filed for any other deductions? It Yes,what deductions?
Yes ❑ No hh G 0
Have you fled for deductions in any other county? If Yes,what county?
❑ Yes ❑ No
UWe 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
Signatur of applicant Address of applicant (number and street,city,state,and ZIP code)
ir
;rte I ii x /8/i 60„ ZAL Z D. / �� -� 47676
Signature of authorize repres- .live Address of authorized representative (number and street,city,state,and ZIP co&e)
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