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: APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
PROPERTY TAX BENEFITS '� Pres ibrmd 4by 708the (e13 pat ent � �� _ (1)9
' Prescribed by the Department of Local Government Finance Jt\ 0111�1
File Mark
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9.
INSTRUCTIONS:To be tiled 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(led 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:During the twelve(12)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 Over 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer)(\),,,Anno, ez � )
Is applicant the egall or equitable owner? Tio,„6,1
what is his/her exact share or interest? If owned with joint tenant or tenant in common,
indicate with whom
❑ No 't�pt��--����ff
If name on record is differXYQes
that of applicant,in'end 1L3 D Do all joint tenants or tenants in common reside on the property?
ppAA JIl3—��, Yes El No
Name of contract seller APR 2 9 2019 Has applicant owned or been buyi the operty under recorded
contract for at least one(1)year fore aiming deduction?
Yes ❑ No
Address of contract seller(number and street,city state,an41264afir Is the property in question:
GIBSON COUNTY AUDITOR
Real property ❑ Mobile home(IC 61-1-7)
Taxing district Key number/Legal description Record number Page number
Cr v1\‘e___ 6e.rfri2-71-01— . 1fi6_02:L.
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$159,999[counting just the homestead site)for the Over
65 Circuit Breaker Credit.)
❑ Yes ❑ No
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? &es
If Yes\h deductions❑ No \\ JHave you filed for deductions in any other county. If Yes,what county?
❑ Yes ❑ No
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of applicant Address
f1f—of/\�applicant (nSmber and street,city state,and ZIP code)
1 'I ' on
Signal of authorized representative Address of authorized representative (number and street,city,state,and ZIP code)