Age_Warren (2)APPLICATION FOR SENIOR CITIZEN couNn TOWNSMIP r�
- . PROPERTY TAX BENEFITS
•S '' SIa1e Fam 43708 (R9l 9-08)
- Preunbed by ihe Departmertl ot Loral GoeemmeM Flnance
FI
Informatiom m�tained in this dowment is CONFIDEN7IAL pursuant to IC 6-1.1-12-9 and IC E1.L3S9.
INSTRUCTIONS:
To be filed in person or6y mail with the CountyAudiforo7the county where fhe property is located. JAN 0.8 .20�3
Filirg Dalas: 7) Real Pmperty: Dunry the tweNe (12) mmfhs befae Decam6er 31 0/ the year the deduction is fo 6e e(!ec(rvs. '
2) Mobile Homes assessed urnler IC Sf. f-7 or manu/acfured hwnes not assessed as real property: Du ' fhe hvelre 7) m s
be/ae Mardi 37 0( fhe year the tleduction is lo be eRective.
cmmue.eue'vValirndAMmnalinelnuiinnenMnunlifi�A�inn.e Rlob�u n��u�r�i w
Type d benefl reque5ad (pleam aD fhat epply)
er 65 Deduclion from Assessed Valuation Over 65 Circuit Breaker Credit
Namadapq'
d appGant �Mka1e babw
tJame d mnraa sener (apprlwnt mvst na�e oeen ouy'uip m cantract at kast o,a (iJ year)
Addrass of mntratl mller (num6ar aM straoL ��y. sLaM, end LP wde) Is ihe pmparty in queslion:
� Real property � Mobile home (IC 614-n
Tazirg d'atrid Key number/ legal dascripcion Rewrd number Page numher
-D�- 03 - DD3. i?Q- ag
U the popeM ���P� M�^T1 �r Assessed va�ua of iha pmpeM as of Mafch 1. Wrcent yaar (may rrof excteM E7ffi,430
hiaherresidance7 forU.er65detlucfian,mS1fi0.000lorNOOrer65Cunil&eal�rCmEif) .
Yes ❑ No
Was I�a appGcaM 65 years of age or mora on December ure year
�re n�+ �ad tor am anar am�m u ia,. wna� aaa�w.or�a
� Yes � No
Hava yw fileE M deductions in any other cwrity7 If Yes, whal courrty?
❑ Yes ❑ No
VWe certify under penalty of perjury lhal the above and foregoing infortnation is true and cortect and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20
cotle)