Age_Boyle s4-' .
4� APPLICATION FOR S IO CINri
COUNTY TOWNSHIP YEAR
1 PROPERTY TAX BE CIO I t
',: RACla\11) 6 2B ?�23
State Form the (R16epa/1-23)
iiizx - Prescribed by the Department of L ov nt
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
Type of Benefit Requested(Please c ec all that apply) ((()))
Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of Applicant(qiKer or c tr ct b yer) Telephone Number / E ail Address
Is Applicant the Sole Legal quitable 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 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 Bought the Property Under Recorded Contract for at Least
One(1)Year before Claiming Deduction? El Yes ❑ No
Address of Contract Seller(number and street,city,state,and ZIP code) Is e Property in Question:
Real Property ❑ Mobile Home(IC 6.1.1-7)
Taxing District Key Number/Le al Description Record Number Page Number
0�`� �-12 -UT-10 -0o2 2q0 -023
Does Applican R ide on Property? Assessed value of the property as of current year assessment date(May not exceed$240,000 for Over 65 Deduction or
$199,999(counting just the homestead site]for the Over 65 Circuit Breaker Credit received before January 1,2020,and$199,999[al
Yes ❑ No Indiana real property]for the Over 65 Circuit Breaker Credit initially applied for after December 31,2019.)See reverse for details.
Is the Applicant 5' ear of Age or More on Decem r of the Year Prior
Have You Filed for Any th Deductions? If Yes, D uctio
Yes ❑No -- 3 i1�� ' �'_ 92023
Have You Filed for D duct n in Any Other ounty? If Yes, t County? eSi
❑Yes No Vl7 Aft y
I/We certify under penalty of perjury that th above and foregoing information is .(� - • %
Oy�. ,
�� Signature
ignature of Applicant / - Date( nth, y,year) yt
1-) g-: giC./._ho_a n . 467//c2_ t'2c( 102_2,
kar4
Actr.it of Appli nt(nKiber and street,city,s 15P code)
Signature of Authorized Representative i - Date(month,day,year)
Address of Authorized Representative(number and street,city,state,and ZIP code)
Signature of County Auditor _ yf Date mo h�da , ear)
\tV\S l
---)C.,b t \‘NrC,"- \il eA C._ ,q-----
DISTRIBUTION: Original-County Auditor; File-Stamped Copy-Taxpayer