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.00, VAN. APPLICATION FOR SENIOR CITIZEN • , IP YEAR
' PR? 2ENEFITSPERTY TAX B
2146 ,____ _ It_ _ nZsr
State5) '�'
'die Prescnbed by the Department of Local Government Finance
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9. JAN 1 4 2026
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, signed, and filed with the county auditor or postmarked by Januar f e c e r.iifr in
which the property taxes are first due and payable. GIBSON C C.G ��1�� 4J
OUNTY AUDITOR
See reverse side for additional instructions and qualifications.
Type of Benefit Requested (Please check all that
If Owned with Joint Tenant or Tenant in Common, Indicate with Whom
❑Yes ETlo —
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 nder Recorded Contract
for at Least One(1)Year before Claim 'g C •dit?
111 Yes El No
Address of Contract Seller (number and street, city, state, and ZIP code) Is the Property in Question
,Real Property ❑ Mobile Home (/C 6-1.1-7)
Taxin 'strict - Key Number / Legal Description Record Number Page Number
lae ./ g -D8 - 204( - ODA • 5 S1 -a J '
- -- -
Did Applicant qualify for the homes d standard deduction in the preceding year (or was applicant married at the time of death to
a deceased spouse who qualified for a homestead standard deduction for the individual's homestead property in the immediately El Yes ❑ No
preceding calendar year)and does Applicant qualify for the homestead standard deduction in the current year?
Is the Applicant 65 Years of Age or More on December 31 of the Year Prior to the Year Taxes are First Due& Payable? EYes ❑ No
ifrer. re of Applicant Date (month, day, year)
111 iiiii
, r (1/4 .P4 r/d.S"1......1--..... _
Ai• ess of Applicant (number d street. city, state ZIP code)
.200q 7 Idt 0ve iNce4e7 W if-7620
Signature of Authorzed Representative
Date (month. day. year)
Address of Authorized Representative (number and street, city, state. and ZIP code)
Signature of County Auditor Date (month, day, year)
DISTRIBUTION: Original - County Auditor; File-Stamped Copy - Taxpayer