Age_Cox- APPLICATION FOR SENIOR CfT1ZEN
; _ PROPERTY TAX BENEFITS
4 � ,• StateFoml]IOBIRt0l13-0B)
RmoNeJ N' Vn Dwsumm d LarA Gwanmlt Rwm
Infarma5on con�aineE in tlas do�vment is CONFIOENTIAL pursuant b IC 61.1.12-9 aid IG G1.1-359.
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File Mark
INSTRUCT10N5:
b 6e fdetl in Gerson n Ey mai wW Ne CounryAWita+d Uro camh wlere fhe F'��M a btateC.
Fdrg Dafes: i) Real Pfoperty Dur'vg Ne �weMe (12) monNS belo.e Oecember Jl W Ne year Me CeCucObn B ro 6e eHeUive.
i) MoEieHarresastessedunderlC6t.tJOrmanutapu�edlqnnsnolasseaseCasrealpropertyDUr'vgtheMeNelf2l�hs
be/ore MarN 31 W Me year Ne Aetlurlion o ro Ee e9eane.
See re�+erse s0e Iw atld4.bna1 iisbcrlions aid 9uafdra0oni.
ryoemee,ern�m�ymy,a �xaw��
Q Over 65 Deduclion hom Assessed Valuation Over 65 Cirwii Breaker Credii
Wiliiarn R. 8linda J. Cox
Is appfra�V Ne We kgal a epMape ow�e/t I tl Na. W0 is IuMV e�aH siwe a iCwli
Q Yes ❑ No
u� o, reme s aaama ma� vm a ao�su.:�aa• ee�w
amet rrr. sare.
�,
�c,y �..,ea i �w*' c�
—i iir�i_
� v�s ❑ No
KbsVae0��65K�d+BertevemDCr M31Wtlie�es
Po ro Pe Y� bzrs se G5 me mtl WY+�i
QtM ❑ No
Ad�usted gross income M applicant, spouse, an0 any
individuals sharing ownership (FOrOver65deducfion, imm�e
may not exceed E25,000; /or Ihe Over 65 Circuif Breaker Gadit,
incorne may irot exmed &30,000 Jw irMividua6, or 540.000 lor
manied coudes). , , _ -
� Yes ❑ No
❑Yes ❑No
MN tm�mne N�b v�an sypse.
.M ra�vn
� a� v�r ❑ Mmao n�e (�c si-i-n
n�e �.,m« Psy� �,.me
9DO. y�l-oa8
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6vr.eneammr�.�.mK�as1 naeaoyaa.vrv.9.�b+w�
Mat wdti Nelp0.tti a epe el tlre Wc
August 19. 1947 °��9
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s.e�ae�aa�vsP
Matgage 8 HanesieadlStandard
I/We certity wWer penalry ol perjury Ihat Ihe above and loregdng infortnaGOn is W e antl correcl and Ihat ihe applimnl was a residen�
of Indiana and owner of the alorementioneC property on Mard� 7, 20 _
�/n` eaqKan y�'9 � .m�ee a wc�+ U..,me..�e.m�. ar. mm. �azw moe�
�/ I�L`Z�r,[, � (� �/ 970 South fdart�s SC Princetm. IN 47670
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