HomeMy WebLinkAboutAge_BurdetteFao3DRenseatfBU AFFIDAVIT OF PERSON� 65 YEARS OF AGEQORO tOR�
�Presui0e0 q ihe Sute '
soaro m ra. w�rsvwiers REQUESTING PROPERTY TAX DEDUCTION
�
TO BE FILED IN PEHSON ON BY MA�L EACH YEAR WITH THE
COUNTY NUDITON WMERE OWNER'S PHOPEFTY IS LOCATED:
REAI PROPEflTY - BETWEEN MApCH t AND MAY 10. INCWSIVE
MOBILE HOME - BETWEEN JANURFY 1 ANp MANCH �t, INClU51VE
(NOi ASSESSED /.5 REAL PPOPENTY) �
e
(61.142-9 AND F1441.10.1)
STATE OF INDIANA, , �C1�L�-� COUNTY, SS:
I, (We)_�J �^� ^A i h� p�-� , certify that I, (We) was/were
� U years of age on the (� ThaE I, (We) reside at
�.2�-a �[�Q�v�� �,��vy�.l�,�GL Township,
(SiFEET OR RURPL OUTE) (GTY OR TOWN)
County, Indiana; that I, (We) have owned the following described
�eai estate
❑ mobile home
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:
Legal Description or Key Number: rT• S• E�I� � E��� - ��' Z�a �• 9s.qc e
�ssessed value of real estate or mobile home as of March 1, current year. ��n—'����
�
_ J s'30 -�30
� ` `� �
e
Wer ither�r?�.'ou o� �spouse required to file an income tax return for the preceeding year? Yes ✓
No���1f�,es�topy of such return must_be submitted for county auditor's inspection.
Other a�} t ge or Contract Deduction, do you receive any' other deduction from property tax?
��HT �����/ Y PP., ,. Y Y' Y
�s �—. Have ou filed a lication for deduction in this Couni or an other count �
�.Lfi �7 N�S .
I swear A1iI3�n'fu�n y of perjury that the above and foregoing information is true and correct.
'See False Statement Pg�+� Below. (On Receipt) �
� �1.� ti .\� �,�,� � � � F3 � P�K) a., �I c� ; �� I � �
Full Name)