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yore,: APPUCATION FOR SENIOR CITIZEN . to ��''�' ��' �s!R
• tiPROPERTY TAX BENEFITS .
Stalb Holm VMS R19-!745 1-hSc 4) Jew
nSCil A(4;3
' tr i lie Proscribed•by tom°01.panmeht of kcal Gc yernmorit Finapcall:
IntOrtDOPT3 PlOacrie4 i tt$s skint tempt Is CONF1PENT1AL.pt rsuarrt to tC 6-1,.1-33-9.
Irnsfrudions7 To be'NO in perms orby 7170 will,fho coanf udr br.of the cow*where,the pmpt‘1514 located.
a`rlrng Date, Form must be completed, signed, ancf lied w.ifh the county auditor or.posinmarked-.00iiimpfy f of the calendar year in
which.tt;e property ryes are hrt.t-.dr gncd payebfe-
&e rev g side hy:gcfdJ r i1 irtetn46$104 and•cgiArif-Jceons:
1y:p4.41101e11t lagtte te-0t:(Pl se'c)1 t t 3
rtpyer 65 1rnuit•13leattfi'Credit
c bayed
; itasined+AiftiowtT�nnt or Tenant In Darnmof,irate
yBs
I P Warne wz f$ecorcl.la Diffespnt the Applicant,t Bt_e netow iPO All*If*Tqraiff4s, :i ,Jde
on Ow rippert'?
i fj too CantiaCt .
Ntfineai tertt74ct Seiler Mail c 1> edtlf 1cdta:eit�i lndrn R d
fc0-4tyYIt'Odl •
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/threat hf Oo ttr:41 Seiler jrturnber WI e4 fly, St>trte.,Mil 21?' oeit9 . . .... .. • — . . .. pF i"tip
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T his 14..-- *Th - • �►{$p er ii 49aj�. tci .
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Did ApIrnarnizuslify fcrtAd n rrrssfesd Standard az,1luCtit+4 tn:tbtt bong yaarr 1orvva4 applicant rnarrfed at:ttse-tie Oi fieath.to I
a dece3ee0d Sp4U90 who quel 031.,tot ac h0tttesteSd starrdatc4 dt,d(mptiori for ttpi,indiyidduars hofnestead property ifi lie immedis.fAt 0 Nc
ptu h ireod9r yttar}and 4oe Appr nrq a1Wy tar oie.norriciatead stanatard.q uptfonid.#he cuMet par? -
le Appli nt65 Years.ofArjs.bf ttiht'e ram:Deoeaitbr31 drtrv•Year prat5r,totlit 1'' s�fTamreBate.Firtt Du llrWaysbie-7 ; L..1r l No
3IWe dertity ut der:pea,*ut peij iiy ttrat the atjava and foregoing irtforrhatto l is Iftmi ,and come
Signature of Appricant, bifiblanaiitth'dal,-,j(
r rrh ` o107 at
•Addneta.cif Appt ni(number cold 0;4 city.£Vale. 0na21P COde)
StA um of Authorized Rc4rrssentative i Date ('many», day, year)
T
Mate, Z huittD Id;Raj raasentabvo(nuu101l8F Wet greet.city, 3ttite, sod ZIP cvds.)-
Signature Of County Auditor 7 Del( 4rdit •-y, ., - -
1,14(f)_1‘...,C.),(-N a__.-9- Q.. . �•,..._; 0.-TV\ �.. 1 , - - I • '
J A N 0 7 2026
pisrfrtldflTtfSN'c pa-igintil- Gout* At,ditcar; Fl3tatfiped Copy - TaxpaYef
(the.c.A441
a. a in4J
GIBSON COUNTY AUDITOR