Age_Strickland"' APPLICATION FOR SENIOR CITIZEN
t . . _ � PROPERTY TAX BENEFITS
Stam Form a37081R9/408)
� S�•u � Prascribed by Me Depanmertl of Loral Govemmem Finance
Irrfortna[bm m�tainetl in Nis tlowmenl is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 61.1-359.
wsrRUCnoNS:
COUNTY TOWNSHIP YEAR
il Mark
APR 9 Zulu
To 6e filed in person or by mail witA Ure CouMyAUdROr o7 the county where tlte property is locafed.
Fili� Dates: 1) Real Pioperty: Dudrg the tweNe (72) mmlhs 6efae December 31 0( the year the deductiwr is fo be eflecti1ee�.i �
2) Mobile Homes assessed under IC &7.1-7 0� manu7actured homes rrot assessetl as real piopery: Dunrg ll+e'(�mlve (Y�,Byinths
Seereversesitlefaetltldronellns3tluCions �eQee��o'snistobeeflective. GIBSONCO�ry UQ�TBR
Type W benefi repuestad (please dieck e0 Nat epply)
�er 65 Deduction from Assessed Valuation Q O�ver 65 Circuit Breaker Credit
Name of aDd�nt (owna ar cmflect Cuye�
� ��i�"�C��w��
Is aoolimm the sole leyal or epwta owneR I( No, what is his/ner exact shara or interestl If owned with somewe other than spouse,
inEipta wit� whom
Yes ❑ No
It neme on recortf is diRe�em Nan thal d appfican� iMicate bebw
Nama oi contrad sallar ( ' nt musl haw Deon b�ying on cmtlact at leasf orre (1J yeaQ
�I �
Add�ess o( mntred seDer numbm eM abeeG Uy, state, aM ZIP code) Is ine pmoe(ty In aues�bn:
�Real pmperty � Mobiie home QC 6-1-7-�
� Taxinpdistnd Keynum6er/Legaldexription Recordnumber PagenumDar
Colc,�mb �. a�-i3-la�co-cbo.9���
Ls ihe propeM useE ari0 ottupied primarily br Asseued value af Ihe p�opeM as ot MarU� 7, wrtent year (may rrot erceed S f 82.d3G
his/har residen�s7 fi�O�er 65 dedud'an, a Sf60,000 /or Ne Over 65 Circuit Breaker Gedi(�
Yes ❑ No
Was the epplimm 65 yeen of aqe v mora on Decembar 31 of che year
Hava you filed fw any olhar deCuctions9 I( Yas, what dedunionsl �
� Yes �No
Have you filed far EeEUytions in any m�er counry? I( T§s, whaf couniy?
� Yes � No
IlWe certi(y under penalty of pe�ury that the above and foregoing information is true and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
Sigr�atu�faopficam � AdCressofapo���ri(numDeia�MSOnot.ciry,slate,a�MZ/Poode)
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� 5' natu�a d euN ed �apreaeMative Mdress ot authonzed rewasentative (numbwa� svoaf. ciry. sfalo. anE LP cotla)