Age_Thoman ' a APPLICATION FOR SENIOR CITIZE � COUNTY TOWNSHIP YEAR
\'yk- PROPERTY TAX BENEFITS �'�/� 1(`'��\..,:'�� Presuibed by Ne Department)of Local Government Finance40In r l - ' 20 ` `
9
A p 9 3 2019 File Mark
Information contained in this document is CONFIDENTIAL pursuant to IC 6'1D 1t359►
INSTRUCTIONS:To be filed in person or by mail with the County Auditor' re the property is located.
Filing Dates: 1) Real Property:Form must be completed ant g%etiNitanktfEjlqiew postmarked by the following January 5.
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as real property Dun we've(12)mon
before March 31 of the year the deduction is to be effective.fl �// LAY
See reverse side for additional instructions and qualifications. V\1 `e)1S-1 _ Cr) ek
Type of benefit requested(please check all that apply) /U1(tI`1� +L `
Over 65 Deduction from Assessed Valuation X ❑ Over 65 Circuit Breaker Credit
Name of applicant( contract buyer)
San$yc, L 1hoir.o-n
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
Yes ❑ No
If name on record is different than at 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 bu n the ro
contract for at least one(1) { p pngy educr recorded
kr� `��.J,\(^J,`•/�vr year be re aiming deduction?
w�p� e( r of Yes ❑ No
Address of con, ct seller(number an street.city,state,and ZIP
III PPcco_de_) �'/ Is the property
in question:
I / of hb2 ; •,• `' , Beak 1\(� f _ ❑/Yteat property ❑ Mobile home(IC 6-1-1-7)
Taxing district Key number/Legal description Re rd number Page number
P1ton 6-12- 1$ -104 -03.31r
Does applicant reside on property? Assessed value of the property as of current year assessment date(may not exceed
S182,430 for Over 65 Deduction or$159,999(counting just the homestead site)for the Over
El 65 Circuit Breaker Credit.)
See reverse for details.
Is the applicant 65 yen of age or more on DeceX3Yes
1 of the year
•
Adjusted gross income of applican ,applicant and spouse, or
See reverse for details. TOTAL S 0.00
Have you filed for any other deductions? HIf Yes,what deductions? ll
Yes ❑ No ` 1 Jkc mqpk L
Have you filed for deductions in any other county? If Yes,what county? _ _ J
❑ Yes ❑ No
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
&hrc'
gnture of applicant J Address of applicant (number and street,city,state,and ZIP code)
•
thorized representave Address of authorized representative (number and street,city,state,and ZIP code)