Age_Spore �`"r' APPLICATION FOR SENIOR CITIZEN
L . 4{ c UNTY TOWNSHIP YEAR
PROPERTY TAX BENEFITS
/ �S'z• - 43708(R16/1.-.1.-...-. O
its PE,-.,--::,.:.: e Department of Lucat Gc(err en;F na _ -3cn 16 2 Z�2 4`I
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 flied with the
Type cf Benefit Requested(Please eck II that apply) ,����
_ ver 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
.{,•^��' •�;�
� rQ , I m 1 Address
Is A.:- • _le Leg or Equitable Owner? If No. What is His her Exact Snare or I e es? If .vn O ed with Joint Tenant or Tenant In Common,Indicate with Whom
_ Yes / No
If Na-re ' ?ecord is D fferreetnt tl yAp Iicant.Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property?
— Yes ! No
I Name of Cort -act Seller Z 1
r Has Applicant Owned or Bougct the Property Under R orded Contract for at Least '
�1` I Ore(1)Year before Claiming Deduction? Yes - No
Address o'Contract Seller(number and street city state and ZIP code' I Is the Property in Que on-
(Real Property Mobile Home(/C 6-1.1-7)
Taxing fis',y �� Key Number;Legal Description I Record Number Page Number
24-12-07-Zo;-e03 3`1-o2g .
Does Appl cant R s,de on Property? Assessed value of the property as of current year assessment date(May not exceed S240.000 for Over 65 Deduction or
Yes
5199.999[counting lust the homestead site)for the Over 65 Circuit Breaker Credit received before January 1.2026 and 5199.999[al
_ No Indiana real property)for
Have You Filed for Any Ot r Deductions? T Y s, Mat Deductions?•
Yes ❑No
s •
Have You Fled for D du ion in AnyOther Cou t'? ' If, s.WhatCounty
I
❑Yes No
IM.'e certify under penalty of perjury that th above and foregoing information is true and correct.
S;gna'i•a of Applicant ------ Date(mon rie7e r,
Ad _of p loam(number street.city eke.and ZIP code)
•
Signature of Authorized Representative f FILE. ip, .year)
7Add-ass of Authorized Representative(number and street.dty.state and ZIP code:
APR 22 2024
I3TZk
- -- - ' Date/, nth. day
GIBSON COUNTY
DISTRIBUTION: Original -County Auditor, File-Stamped Copy-Taxpayer