Age_Blake ,, •.a. APPLICATION FOR SENIOR CITIZEN C UNTY TOWNSHIP YEAR
c/ l PROPERTY TAX BENEFITS
�' State Form the IRIS/1-20) ��� ^ \ n
" " Prescribed by the Department of Local Government Finance (lei* �l, 71•'.�"` SS
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.
'Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit "�
riCA
Name of applicant(owner or con cf uyer) - kej .
1 �� a.I 8 Ke 0'yb �� W I�I ►tent/
Is applicant the sole legal or equitable owner? If No,what is his/f er exact share or interest? If owned with joint te nt or tenant in corrlmon,indicate with om.
❑Yes ❑No
1 If name on record is different than that of applicant,indicate below. I Do all joint tenants or tenants in common resid: . the prbperty?
il Yes ❑No
Name of contract seller Has applicant owned or been buying the property unde re .r ed contract for
at least one(1)year before claiming deduction? Yes ❑No
Address of contract seller(number and street,city,state,and ZIP code) I property in question:
Real property ❑Mobile home(IC 6-1-1-7)
Taxing district 0 2 Key number/Legal description Record number Page number
2b-'2-18 -301—Od0.03\— O2_S .
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
es. ❑No (counting 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 1 of the year
$
Have you filed for any other deductions? If Yes,what deductions?
•
t ['YesV o
Have you filed for deductions in any othert y? If Yes,what county?
Eyes 1°4 No
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
t
(Sign tune o13,51icartt Date(m nth, ay,year)
ddress of app( fit (number and street,city,sta d ZIP code)
'06l �curNe_ `AYc- 1' r-J�— 111-(,R.
Signature of authoriz d representative •1 Date(month,day,year)
Address of authorized representative (number and street,city,state,and ZIP code)
Signature of County Auditor Dat (m a, ear)
�ukA4 _ (")".\
� FILED z� .
APR 2 6 2023
f ; 1a. a�4)
GIBSON COUNTY AUDITOR