HomeMy WebLinkAboutAge_CoxPoro 7n Fevisea 1980
P�escrioeA by �ne State
Boa�� af ia. Commissioners
I/ _ ..::\
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ATE OF
real estate
❑ mobile home
AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE
RE�UESTING PROPERTY TAX DEDUCTION
TO BE FILE� IN VEFSON OF BY MAIL E>CH YEAR WITH THE
COUNTY AUOITOH WNENE OWNEN'S PROPERTY IS LOC<TED:
NEAL PHOPEHTV - BETWEEN MANCN 1 ANO MAY 10. INCLUSIVE
MOBILE MOME - BETWEEN JANUAfl1' t AND MAFCH ]l, INCLUSIVE
(NOT ASSESSED AS PERL PROPERTY)
�
of age on th
(41.142-9 ANU 61.14240.1)
� � ... 1
oC�l -Do131
TY, SS:
� u/�-�'�r• �, certity that I, (We) was/were
. Thaf I, (We) reside at
Township,
ty, Indiana; that I, (Wej have owned the following described
for 1(one) year or. more prior to claiming this deduction, and That I, (We)
now reside in the premises for which this deduction is claimed:
Surviving Spouse: If application is being made by a surviving unremarried spouse:
Spouse's age at time of death:
Name on property tax records if dif nt from \ab^ove:
�-egal Description or Key Number. � A ' L! � l/ '"J �
�ssessed value of real estate or mobile home as of March 1, current year:
r� %-.3 - lC�C .
0 - 1330 �
The total annual gross income of this affiant when combined with that of his or
her spouse for the prior calendar year, without any deductions, did not excee
511,000 and was derived from the following sources and in the followin '
amounts:
E pF INCOME
............................S
...........................5
.............................5
TOTAL..S
AMOUNT OF INCC�ME,
�— �
yA� ^'TOF
Were eit r you or your spouse required to file an income tax return for the preceeding .year,? Yes
No If yes, a copy f such return must be submitted for county auditor's inspection.
Other than a Mortgag or ntract Deduction, do you receive any other deduction from property tax?
s� NO Have you filed application for deduction in this County or any other county?
; N O
I swear under penalty of perjury that the above and foregoing information is true arid correct.
'See F e St�tement Penalry Below. (On Receipt)
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iull Name)