Age_Gottman e%-1 .c. APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
7;' 'ter:::° PROPERTY TAX BENEFITS �� ��
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(pie check all that apply)
Over 65 Deduction from Assessed Valuation El Over 65 Circuit Breaker Credit
1
Name of applicant(owns or contract buyer)
I or equiitab ner? 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 that of applicant n ca b�w �� Do all joint tenants or tenants in common reside on the property?
,Yes CI No
Name of contract seller j AN 0 3 2020 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,slate,a IP cb Is the property in question:
����@� OOUNTY AUDITOR Real property ❑ Mobile home(IC 6-1-1-7)
Taxing district
the homestead site]for the Over
65 Circuit Breaker Credit)
❑ Yes ❑ No
.
$25,000;for the Over 65 Circuit Breaker Credit,income may not )
exceed$30,000 for individuals or$40,000 for married couples.). $
See reverse for details. TOTAL $ 0.00
Have you filed for any other deductions? If Yes,what deduction?
Xes
❑ No H S
Have you filed for deductions in any other county? If Yes,what county?
❑ Yes X No •
I/We 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)
.1/77 55 3 -sr 0 -S A_ 6 q .
gnature of authorized representative Address of authorized representative (number and street,city,state,and ZIP code)