Age_McKannan"' APPLICATION FOR SENIOR CITIZEN cour+rr TOWNSHIP I YEAR
. PROPERTY TAX BENEFITS r !^ ° T �
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� �� arasc�cea try me oeoarm,em ot towi covemmem F�nanca -��
Fle Mark
Informatbm m�tained in Nis docvment is CONFIDENTIAL pursuant W IC 6-1.7-72-9 antl IC E7.7-35-9. .J L L 6 2009
INSTRUC710NS: �/
To be fi/ed In person or by mall wifh the CqurttyAUdrlw o/ the county where fhe property is locafed. 4»a� �i.y-g
Fding Dates: 1) Real Property: Dunrg the fweNe (72) maRhs before Decem6er 3f of the year the deduction is fo be ef/ecrtivqe.��U p�J U
2) Mo6ile Hanes assessed urMer IC 6-7. 7-7 or manufectured homes rat assessed as reel property: Dunrg D��6f0.�6NB �z)��isp'UDIT�R
be/ore MaN� 3f o/the year the deduc6on is to be ei(ective.
See reverse side for eddifionel insWUions and pualificstions.
TY7e d heneft reaue9ed (P�eese tlietk a9 Naf apply)
�Over 65 Deduclion from Assessed Valuation �Over 65 Circuit Breaker Credit
�
Name of a0W��1(onT+er or ca^hacf DuyaQ
U aDD��� �he su�e Iepal oreQUitaWe owne/1 tl w�at is his/ha� ea d sture w interasl7 It owned with saneone olher than SDOUSe.
indiate with whom
Y� o No
I( name on recoN is Eifterem than Ihat of apdi�nt, irWlcate bebw
Name of cont2G seller (applicanf musf fuvo boon buying m conffatt at bast ono (1) yreah
Addtes9 of mntratl m0ar (numbaeM sbeet, cify, sfafe, and ZlPWEO) Is Ihe pmoeM � auestion:
eal pmperty � Mobile hama (IC 6-7-bn
� Tazing d'utricl Key number / Legal descnolion Record num0ar Page numbar
� �13-1 -��l-boD. �a - bS
is tha pmpeM used a'M accupied primariry br Assessed value of iha pioDeM as ol Ma¢h 1, curtant year (may not erceeC 518I.d30
hisihar (eaMence7 Ior Orer 65 deduction. a 5760.000 for Ne Ove� 65 Circ�il &eaker Gedi�
�'es ❑ No ���
Was the appGCeM 65 yeafa of ape or mora on December 31 d ltre year
Hava you filetl br erry other deCuctions7 �� Ws. whal daE�cGOns'/
� Yes ❑ No
Have you fued for Eaductioru in any othar coumy? If l§s. what counry?
❑ YeS �d0
I/VJe certify under penalty of perjury that ihe above and foregoing information is true and corred and that the applicaN was a residenl
. of Indiana and owner of the aforementioned property on March 1, 20 _ •
Signat da00GraN /dCressofeDP�m (nunOwe�MStroef.crystare.aNZ/PmLe)
�^ � —
� ura orized �e0�eaeMative Addre39 019Nhonxed rep�B50�IetivB (numbera� treet ��b. gab, and LP cro0e)