Age_Hurt .,. • APPLICATION FOR SENIOR CITIZEN ^ COUNTY TOWNSHIP YEAR
• PROPERTY TAX BENEFITS
Prescribed by the Department of Local Government Finance
File Mark
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9.
INSTRUCTIONS:To be filed in person or by mail with the County Auditor of the county where the property is located.
Firing 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 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 a8 that apply) X
CIOver 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name o(epp8ram(ownwwcontraU buyer) --�-
Is applicant the sole legal unable owner? If No,what is his/her exact share or interest? If owned with joint tenant or tenant In common,
X:es
indicate with whom
CINo
If name on record Lsdifferthat of applicant,Indicate below Do all joint tenants or tenants in common reside on the property?
FILE 'i1,' ❑ Yes ❑ No
Name of contract seller i t p
HasfQnt owst o one beenar bngt the meetly under recorded
contract for at owned or been bu befo aiming deduction?
����pp�y/ rttt ''nn rn1 es ❑ No
Address of contract seller(number and street.city.stale d s9P co2aQl J Is the p rty in question:
Real property ❑ Mobile home(IC 6-1-1-7)
Taxing district egal desolation R rd number Page number
GIB N OuNTYAUDITOR
(0-1S-2_,o 3 o0-0co.32r-a>15
Does appfmant reside on properly? Assessed value of the property as of current year assessment date(may not exceed
$18Z,430 for Over 65 De ducdon or$159,999(counting just the homestead site]for the Over
❑ 65 Circuit Breaker Credit)
ElYes No See reverse for details.
Is the applcant 65 years of age or more on December 31 of the year
Have you filed for any other deductions? X:es
If Yes,whatL deductions? ,� —t/,
❑ No '(}/''�J� �Ti A4 (J�.�� e •
Have you fled for deductions In any other cou ff Yes,what county?
J
❑ Yes •
I/We certify under penalty of perjury that the above and
foregoing information is true and correct.
.Signature of applicant Address of applicant (number end street city,state,and ZIP code)
e� 223�I S CSO ) Fvnvs w \1^1 6
Signature of authorized re native Address of authorized representative (number and street city,state.end ZIP code)
...evaz, APPLICATION FOR SENIOR CITIZEN / OUNTY TOWNSHIP YEAR
'4E PROPERTY TAX BENEFITS V /// //��
State rcrm the(ep3/415) Son / �! 1�
Prescribed by the Department of Local Government Finance (Wp'1j 2mil +\ _I
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 tiled 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 a9 that apply)
❑ Over 65 Deduction from Assessed Valuation IA I Over 65 Circuit Breaker Credit
Name ofa at(owner or contract buyer)
Is applicant the sole legal or equitable amen If Na what is his/her exact share or interest? If owned with joint tenant or tenant in common,
intimate with whom
Yes ❑ No
If name on record is ddferd�t at of applicant,intimate below Do all joint tenants or tenants in common reside on the property?
Name of contract seller FILED ❑ Yes ❑ No
Has applicant owned or beenr
under recorded
contract for at least one(1)yeeduction?
MAY9 2019 ❑ No
Address of contract seller(number and street,city,state,and ZIP code) Is the pro in question:
�ip • Real property ❑ Mobile home(IC 6-1-1-7)
Taring district iEl% OR R rd number Page number
Cc/ �CV . a6-132b zoo - 0003isto 5
Does lireside on property? Assessed value of the property as of anent year assessment date(may not exceed
$182,430 for Over 65 Deduction or$159,999(counting ryst the homestead sire)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? If Yes,what deductions? �� p
Yes ❑ No H S 1� -�y t
Have you fled for deductions in any other coon If Yes,what county?
❑ Yes ❑ No •
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
•
XEZ2L_ as-
e o Address of applicant (number(number and street city,state,andZIP coda
Z?3 `1 S Cso P S co —ih^� 49l
Signature of authorized repress Address of audio.' representative (number end t city,state,and ZIP code) •