Age_Singleton `"'TM APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
.."- PROPERTY TAX BENEFITS
x; � ,. �� 00G 2.2cStale Farm43708(R16/1-23)'•i• vPrescribed by the Department of Local Government Finance
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(Please check all that apply)
_• •ver 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
flame of Applicant ne or cont act. ye
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 U der rded 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 t roperty in Qu ion
eal Property ❑ Mobile Home(IC 6-1.1-7)
Taxing District D /� Key Number/Legal Description Record Number Page Number
(mac 26-13-3.4-7o 0-1001 , I -, d G
Does Applicant es' a 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
filed a joint return with the individual's spouse.)See reverse for details. TOTAL $
Have You Filed for Any then eductions? If Yes,What D uctions?
es El No *� � 1 (k o)
Have You Filed for ucl n in Any Other C nty? If Yes,What C unty? '
❑Yes No
IIWe certify under penalty of perjury t t th above and foregoing information is true and correct.
Signature of Applicant Date(month,day,year)
�`
dd r ss A icanl(number and street,city,state,and Zl �
q t 1 'E o o S 0la4, c. 0 ,Y) —\-'O-LZ 0
Signature of Authorized Representative r Date(month,day,year)
Address of Authorized Representative(number and street,city,state,and ZIP code)
Site of Coun itor r Daro t d y 2r -
FILED (`fit`
AUG 0 9 2024
DISTRIBUTION: Original—County Auditor; File-Stamped Copy—Taxpayer
a d
GIBSON COUNTY AUDITOR