Age_Young - 411.111111111
dam". APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
is - PROPERTY TAX BENEFITS
t
f State Form d by ep3t4-15) ________
Prescribed by the Department of Local Government Finance
Fill a ,.
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. + 1 i
INSTRUCTIONS:To be tiled in person or by mail with the County Auditor of the county where the property is located. APR 1 7 2018
Filing Dates: 1) Real Property:Form must be completed and signed by December 31 and filed or postmarked by the following January 5.
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as real property Du the tw months
before March 31 of the year the deduction is to be effective.
See reverse side for additional instructions and qualifications.
GIBSON COUNTY AUDITOR
Type of benefit requested(please check all that apply)
WOver 65 Deduction from Assessed Valuation OP Over 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer)
1\k Is appliwn the sole legal orble owner? If No,what is his/her exact share or interest? If owned with joint tenant or tenant in common,
II��n�//��"""""" indicate with whom
������Rys ❑ 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?
�-res ❑ No
Name of contract seller Hasa applicant owned or been buying ur
pp year before a property under recorded
contract for at least one(1)year before daiming deduction?
❑ Yes C No
Address of contract seller(number and street,city,state,end ZIP code) Is the property in question:
Real property I I Mobile home(IC 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
4(, - (e ;p13 - ibo —boggal,ob`t
Does applicant reside on property? Assessed value of the property as of current year acceccment date(may not exceed
5162,430 for Over 65 Deduction or 5159,999(counting just the homestead site)for the Over
❑ NO 65 Circuit Breaker Credit)
IVYes See reverse for details.
Is the applicant 65 years of age or more on December 31 of the year
�� �-
Have you filed for any other deductions? If Yes,what deductions?
❑ Yes ❑ No
Have you filed for deductions in any other county? If Yes,what county?
❑ Yes ❑ No
IIWe 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)
rize„ '(, 6� C r 3of and 5 /755 Fr tidtci t. co =N Li 7(//9
gnature of authorized represen e A cuss of authorized representative (number and street.city,state,and ZIP code)