HomeMy WebLinkAboutAge_StoneFa�� m xeasm �seo AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE
Rewi0e0 Ey tne Sta:e
eoam oi ta, rA�iss�ers REQUESTING PROPERTY TAX DEDUCTION
TO BE FILED IN PERSON OR BY M/IL E/CH YEAN WITH THE
COUNTY I.UDITOq WHERE OWNER'S PROPERTY IS LOCATED:
REI.L PROVENTY - BETWEEN MARCN 1 AND MAY 10. INCLUSIVE
�' MOBILE HOME - BEiWEEN JANUART t AND MAflGH �1, INCWSIVE
(NOT PSSESSE� AS PERL PROPERTY) /�
J (6-1.1.1]-9 AN� 61.L1240.1) � D O' _`�0��,
STATE OF INDIANA, COUNTY, SS:
I, (We) - �� �-�� , certify that I, (We) was/were
!,, �� �(�`
w� years of age on the � . That I, (We) reside at
'"\�� I�d � �� Township,
�STREET OR RURAL OUTE�,� ,�, � � 1�QTV OR TOWN)
���'N--�'^U County, Indiana; that I, (We) have owned the following described
real estate
for 1(one) year or more prior to claiming this deduction, and That I, (We)
❑ mobile home
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 different from above:
��gal Description or Key Number: �! • J`(�'r � �`i W r'� — � �-3-� ��1f��,
Assessed value of real estate or mobile home as of March �, current year: �U7D-3(iri�
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 exceed
511,000 and was derived from the following sources and in the following
amounts:
SOURCE OF INCOME
AMOUNT OF INCOME
.�.C��o ��' . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S I 5 D • (o �
�?�ti.e.�-,�e. . . . . . . . . . . . . : . . . . . . . . . . . . . . . . s l k (.Q a • `f 9
(�,�J� . . . . . . . . . . . .. . . . . . . . . . . . . .. . . s 8 5 a o . o p.
TOTAL..S I U J� `� • I�
Wer���y�tir'spouse required to file an income tax return for the preceeding year? Yes ��
No If yes, a copy of such return must_be_submitted for county auditor's inspection.
MAY 2 5 1989 �
�her than a Mortgage or Contract Deduction, do you receive any other deduction from property tax?
es/ �Have you filed application for deduction in this County or any other county?
Ye5 � �
I swear under penalty of perjury that the above and foregoing information is true and correct.
'See False Statement Penalty Below. (On Receipt)
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