HomeMy WebLinkAboutAge_Nixon ),„ APPLICATION FOR SENIOR CITIZEN OUNTY TOWNSHIP YEAR
PROPERTY TAX BENEFITS
�' i� State Form (R15 t 1-20)
. ''' Prescribed byy the
e Department of Local Government Finance � `/1
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
Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of pplicant(o��,,yy1////d�er r cont ct �er) ��' ,
Is applicant the so a Idgale . ble owner? If N what is h s/her exact share or interest? If owned with joint tenant or tenant in common,indicate with whom.
Yes ❑No
If name on record is diffe ent han that of applicant,indicate below. Do all joint tenants or tenants in common resi.-on he property?
i�Yes ❑No
Name of contract seller Has applicant owned or been buying the property under .•,rd- contract for
at least one(1)yea before claiming deduction?
V es ❑No
Address of contract seller(number and street,city,state,and ZIP code) I t e property in question:
Real property ❑Mobile hom- (/C 6-1-1-7)
Taxing district
Yes ❑NoIS fiv
Have you filed for deduction n an othe co ? If Yes,what county?
El Yes No
I/We certify under penalty of perjury th t the above and foregoing information is true and correct.
Signature of applicant Dat.4i th d
Add e of applicant (n r and street,city,state,and ZIP code)
Signature of authorized representative Date( :l3y year (,-2., ::.Add ss of authorized{epresentatiivve\ umber nd st t, 'ty,state,and ZIP code) .()
Signature of Cork Aud.or _ Date(month,day,year)
1 v3
FILED
AUG 2 6 2022
GIBSON COUNTY AUDITOR
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer