HomeMy WebLinkAboutAge_Trust �.rs r APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
7 _ �A PROPERTY TAX BENEFITS FTLEDL04\Prescribed by the Department of Local Government Finance ��
�4�R 2 2 2022 File Mark
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-3 /j6 e(t
INSTRUCTIONS: To be filed in person or by mail with the County Aud th ty�ythe�etrbpe(ty is located.
Filing Date: Form must be completed and signed by December 31 Ar7 )11,,f i CtaYntt t 1d&JiT&Fr postmarked by the following
January 5 of the calendar year in which the property taxes are first due and
IZI Over 65 Deduction from Assessed Valuation ®Over 65 Circuit Breaker Credit
Name of applicant(owner or contract buyer)
Lloyd Family Trust (Martha lloyd)
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 El No
If name on record is different than that of applicant,indicate below. Do all joint tenants or tenants in common reside on the property?
❑Yes El 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? ❑Yes ❑No
Address of contract seller(number and street,city,state,and ZIP code) Is the property in question:
III Real property ❑Mobile home(/C 6-1-1-7)
Taxing district Key number/Legal description Record number Page number
028 26-12-07-402-001.639-028
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
®Yes ❑NO tcounting just the homestead site]for the Over 65 Circuit Breaker Credit received before January 1,2020,and$199,999(all Indiana real
property]for the Over 65 Circuit Breaker Credit initially applied for after December 31,2019.)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?
1IYes ❑No Hstead
Have you filed for deductions in any other county? If Yes,what county?
El Yes 0No
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
XSign a of applicant Pc� (� Date(m nth,Q�y,�e ^
Address of applicant (number and street,city,sta ,and ZIP code) 1 '"`' Z(/ (�
807 E Water ST, Princeton, IN 47670
Signature of authorized representative Date(month,day,year)
Address of authorized representative (number and street,city,state,and ZIP code)
Signature of County Auditor Datet(nGn2 Stay, ept 2
MIDI is L �
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FILE
APR 2 2 2022
GI COUNTYD
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer