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"'"w APPLICATION FOR SENIOR CITIZEN � COUrliv TOWN v Yenfi
_ _ . PROPERTY TAX BENEFITS �
Stata Farm 43708 (R9 / 9-08)
�O f Prawibad by the Departmenl of Local Govamment Fnance
� In(ormatiom m�tained in ihis document is CONFlDENTULL pursuant to IC 61.1-12-9 and IC 61.7-359. ryf R G 0�`�'c
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INSTRUC710N5:
To 6e ned in persm or by mail with fhe CountyAUtlitor ol (he munty where the property is locafetl.
Filing Dates: 7) Real Property Dunrg fhe fweNe (12) mmlhs 6efae December 31 0l the ysar fhe d
2) Mo6i/e Homes assessed urMer IC G7.7-7 or manulactured hanes rrot a sl
belora March 37 o7tAe yearthe deduction is to be eflective.
See reverse side /or adddional insWGions and qualifica(ions.
Typa d CeneH rapuested (please rheck a0 Naf appty)
❑ Over 65 Deduction 6om Assessed Valu ' n I R Over 65 Circvit
T\
NamaofappG�M(owrrororcanfractbuWd �
L
❑ Yes ❑ No
II nama on racad'u d'MareM Uian that o(appGont ifu
Nartre ot contrsd 5e0er (appGCant must hare
H ty6, what
pmperly in questron:
�eal property � Mobile home (IC 6-14-�
Recmdnumber Pagenurber
IIWe certify under penalty of perjury that the above and foregoing information is true and co�ect and thaf the applicant was a resident
o( Indiana and owner of the aforementioned property on March 1, 20
S�ign/¢�uradaPd� nt AddressofaP7�nt (num6eranOSboef,tity,s7a�.aMZlPwde) -�
( '��� �� � . VM�IA� L �b Ta
SignaturedauNOr¢aArapresentative PdtlressolaWhorimd2presentative (numberarMSlree4u�Y.sTate,andLPCatle)