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Age_Graves APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR . PROPERTY TAX BENEFITS . State Form the 1-20) LSO n CO5 22 . --�� Prescnbed by the Department of Local Government Finance V� W 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. 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(P/ease check a//that apply) 0 Over 65 Deduction from Assessed Valuation I�Over 65 Circuit Breaker Credit Name or applicant(owner or contract buyer) 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. B Yes ❑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 ❑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: ®Real property ❑Mobile home(iC 6-1-1-7) Taxing district Key number I Legal description Record number Page number Francisco 26-13-20-101-000.183-005 Does applicant reside on property? Assessed value of the property as of current year assessment date(May not exceed S200,000 for Over 65 Deduction or$199,999 Yes CI No (counting just the homestead site)for the Over 65 Growl Breaker Credit received before January 1.2020,and$199,999 fall Indiana reel EI property)for the Over OYes El No Homestead Have you filed for deductions in any other count If Yes,what county? ❑yes o I/We certify under penalty of perjury that the above and dffforrregoinggiinformation is true and correct. Signature of applicant �� C.._ �� . J"1 _.� Date(month.day,year) s,��-,c�5r+.) %`, 3/10/2022 Address of applicant (number andstreet,city,stgte,and ZIP code) PM 43/07 E- ittavx. ) a tZt_D ' 7 1/ 9 Signature of authorized representative Date(month•day,year) Address of authorized representative (number and street,city,state,and ZIP code) Signal re of County Auditor Date(month,day,year) 4.1110¢.2-- 4. bijkii15, ,c )_ FILED - MAR 1 0 2022 ,/ .j DISTRIBUTION: Original-County Auditor: File-Stamped Copy-Taxpayer 'l ,lr ✓�/ZcctZG At a C nal 5— GIBSON COUNTY AUDITOR