HomeMy WebLinkAboutAge_Lance 4�%"�� APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR
Gl' a PROPERTY TAX BENEFITS —
t ;/� Slate Form 43706(R15/1-20) C0^ 1 0 O 2_3
\ f Prescribed by the Department of Local Government Finance `�v_ 1 +
File Mark
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-35-9.
INSTRUCTIONS:
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I/We certify under penalty of perju t of the above and foregoing information is true and correct. Oyes r 2�e0
Signatur ppli ant Date(erdalit , ar) <J7
A --/E O0Address of applican (numir,
street,city,state,and ZIP code) �T
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Signature of authorized repres nlative Date(month,day,year) -r
Address of authorized representative (number and street,city,state,and ZiP code)
Signature of CountyAuditorr\^ \ t \ f)at�(meRfh,day,�r�
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