HomeMy WebLinkAboutAge_VanmeterFo�n 727 fleviseE t9B0
=0esuiEea by �Ae S�aie
BoarE ol Taz Commissioners
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AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE
REOUESTING PROPERTY TAX DEDUCTION
TO BE FILED IN PERSON OH BY MRI� EACN YE/N WITH THE
COUNTY AUOITON WHENE OWNER'S PROPERTV IS LOCATED:
REAL PNOPEPTY - BETWEEN MAHCN 1 AND MAY 10, INCLUSIVE
MOBILE HOME - BETWEEN JANUAPY 1>ND MARCH Jt, INCLUSIVE
(NOT <SSESSED AS REAL VROPERTV)
(St14Z-9 ANO 61.1-12-10.1)
�! years of age on the �
Q. Ii2. 3. ��c 9g f�' C�
real estate
❑ mobile home
Q01-D108)
COUNTY, SS:
certify that I, (We) was/were
That I, (We) reside at
Township,
unty, Indiana; that I, (We) 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 different from above:
!t��gal Description or Key Number: �J' �� �— S� �-3' 9 53 �4 L
�ssessed value of real estate or mobile home as of March 1, current year: ��'73O ��7���
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
S71,000 and was derived from the followirig sources and in the following
amounts:
E OF INCOME
5C.
............................S
.....:......................S
.....:......................5
�r�i��
AMOUNT OF INCOME
� ..
Were either you or your 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 ins ection.
O.ther than •a Mortgage r Co tract Deduction, do you receive any other deductio���ro�ty`tax?
-��s NO �ave you filed application for deduction in this County or any other county?
S "o MAY 1 � 1390
I swear under penalty of perjury that the above and foregoing information is true and�correct.
'See Fal� tatement Penalty Belpw. (On eceipt 114rr�S
� • —
� � � e � AUDITOR �
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