HomeMy WebLinkAboutAge_Chandler 74 w APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
PROPERTY TAX BENEFITS k�0� O G"�_' State Farm 43708(R15/1-20)
e �s,s e' 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. 2`
INSTRUCTIONS: To be filed in person or by mail with the County Auditor of the county where the property is located. . Mo., \ .
Filing Date: Form must be completed and signed by December 31 and filed with the county auditor or postmarked by the following
January 5 of the calendar year in which the property taxes are first due and payable.
See reverse side for additional instructions and qualifications.
Type of benefit requested(Please c ck all that apply.)
ver 65 Deduction from Assessed Valuation ver 65 Circuit Breaker Credit
Name of applicant(owner or cont act b er) ` + r_1 /-y C e&
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 that of applicant,indicate below. Do all joint tenants or tenants in common reside o e property?
Yes ❑No
Name of contract seller Has applicant owned or been buying the property under recorded contract for
at least one(1)year before claiming deduction? EI Yes ❑No
Address of contract seller(number and street,city,state,and ZIP code) Is the operty in question:
Real property ❑Mobile home(IC 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
26-11-01 - (0y _000- 665--0-aZ
Does applicant reside on property? Assessed value of the property as of current year assessment date(May not exceed$200,000 for Over 65 Deduction or$199,999
[
$
individual's spouse.)See reverse for detail
Have you filed for any other deducti If Ye sty ctio s?
Yes ❑No 'T(�j �?
Have you filed for deductions in any other county? If Ye sty
county?
❑Yes ❑No
I/We certify under penal y of perjury that the above and foregoing information is true and correct.
\/x\i- Sig maureof app'cant4r--07 Date(m( .5) yer)_ 2_2
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\ A'. --•s of applicant (number and street,city,state,and ZIP code) ` ``1l l'4/ /Vl'
Signature of authorized representative Date(month,day,year)
Address of authorized representative (number and street,city,state,and ZIP code)
Signature of County A r Date(month,day,year)
`►��..��"'� FILF,D
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(1') \ JAN 0 4 2022
�� GIBSON COUNTY AUDITOR
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer