Age_Wilder ^�'°� APPLICATION FOR SENIOR CITIZEN correct I TONR:Saq., YEAR I
PROPERTY TAX BENEFITS �../T` T ���r�q�j
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Information rename$in uus postmen is CONFIDENTIAL pursuant to IC 5-1,1_S9. OCT
N'ST.RSCTIONS. OCT 4 20(4
q oe Nes in permn or ay mad vats me County Auditor of Me county veer.toe NDY_oy is bated.
Fang I) Ass/Property Form must be mbnol_.e=anc signer by Dw.ernoer 3t and fired or nosznanrec mime ialnatng January 5
2) Waite.'tomes assesses under IC fel.I-i or manuaaurec names no:assessed as mat nmoeny Outing the 61.8g5
Jean Alarcon 3;of the year the oesuaon is to.he efietive. J COUNTY AUDITOR
See reverse sate for ass:ad.al atsouoons and auaefiadons.
yx of stet rearrests:(-rase medF MIME atoty,
i''Dver ES Deduction front Assessed Valuation 11✓Over ES Circuit Breaker Credit
Name of aac nt former ar arras ouye
j2lagg &Id 2JIIoM
Is op ts::the sole legal or eamane m.n.p it Ne,said is nislh r sae snare r e.:eren% If mown w},Imo:lenam or levant o metes.
Scale wows=
Les I I No
goon.or.resort is S=erer:than eta!_applicant nave xL Da at pm tenants or tenants in anon r_se en me orooem?
I_J yes I I No '
Nang of more=seller Mae any nt bans Cr Deer.oeh'vn Me accerty utter recaa_a
castes ta-at least one(1)year Defer,Pa_ny wean%
•
I Ive, eI INo
400reu at.galas seller Inu.-xr ant Yta:ay tare.air ZIP am) Is the totem a avesa_':
s.l Real pmoerry I I Mood=_Dome(IC 6-1-I-71
Itan,:assn Key reme'/Legs I a'ri'a 7`Strom ouster Par r:rw'
%Gtr £-/e2,o9dao -0oa.aao-oa7
Does aa3-ant reside an, very% Assess[sense of the property a,of Mara.1,ynee:yen fray arzra S182,tat
am Deer es maraca.or St 1,000 la ma k'65,^vue t eate:lest,
Iva I No attar vzs.;ao)
Is me aotasnt 62 years at ape store cr.Decemeer a',of me year &
e yu Sec for arty oaeoasma-si C res.w:at teatmans?
I gee II/Nlc
we Set Mr aewans r.an)'one'smann% If ,`anal aunty%
paw II yes I K Ne
IANe certify under penalty of peerjury that toe soave anc foregoing into nation is true and mnem.
ore of aoer nt strews of am6oa:t(number a,c sox,pay tote,anc Ztn ax) [J 7/
d - / A 1 V / (O
yc a __2 i� _/ 15 _- -A I L// /7/ /_ _i 1 '
Isisatture oM 1oru__._vesenawe Actress ai auucmea rtor_senaose Into[ ant nee;try tare.ant Lo aael 't