Age_Garrett i
-Al APPLICATION FOR SENIOR CITIZEN couNTY TOWNSHIP YEAR
' PROPERTY TAX
!: :ment Finance at
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9.
AUG 2 4 2017
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:Form must be completed and signed by December 31 and filed or postmarked by the fol. in.tia,r-._a(
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as real prope .'t,/. + '•;lflf- onths
before March 31 of the year the deduction is to be effective.
I� • ' • Y •UDITOR
See reverse side for additional instructions and qualifications.
Type of benefit requested(please check all that apply)
Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer)
t✓ A R _�IX '£ `, _). MAD
Is applicant the sole legal or equitable owner? If No,what is his/her exact share or interest? If owned with joint tenant or tenant in common,
indicate with whom
I[Yes ❑ No
If name on record is different than that of applicant,indicate below Do all joint tenants or tenants in common reside on the property?
❑ Yes ❑ No
Name of contract seller Has applicant owned or been buying the property under recorded
contract for at least one(1)year before claiming deduction?
❑ Yes ❑ No
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
Pi 4X C-N? ..r. -�wT °L -(9 - aDD •te:n.(4.(1'0 c71
Does applicant reside on property? Assessed value of the property as of current year assessment date(may not exceed
5182,430 for Over 65 Deduction or 5159,999[counting just the homestead site)for the Over
❑ No 65 Circuit Breaker Credit)
Wes See reverse for details.
Is the applicant 65 years of age or more on December 31 of the year
❑ Yes _,o
me certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of applicant Address of applicant (number and street,city state,and ZIP code)p
gnature of authorized representative ddress of authorized representative (number and street,city,state,and ZIP code)