HomeMy WebLinkAboutAge_Riddleiam 323 Rertatf 1981
Preszri� by Ne 9a;e
� BwrU ol iaR fummissioners
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STATE OF INDIANA,
/95S
AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE
RE�UESTING PROPERTY TAX DEDUCTION
TO BE FILED IN PERSON OR BY MAIL EACH YEAR WITH THE
COUNTY AUDITOR WHERE OWNER'S PROPERTY IS LOCATED:
REAL PROPERTY BETWEEN • BETWEEN MARCH 1 AND MAY 10, INCLUSIVE
MOBILE HOME • BETWEEN JANUARY 1 AND MARCH 31, INCLUSIVE
(NOT ASSESSED AS REAL PROPERTI�
(61.1-12-9 AND 57.1-12-10.1)
C � _ S ��� -
� _�
, .S.S:
I, (We) / � , certify that I, (We) was/were
�-S years of age o the� ��. That I, (We) reside at
, � -�� ' � �� Township,
(Street or Rural Route) (City or Town)
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) now reside in
❑ mobile home
the premises for which this deduction is claimed:
Surviving Spouse: If application is being made by surviving unremarried spouse:
Spouse's age at the time of death: . .
Name of property tax records if different frQm above:
Legal Description or Key Number:
7
`�ssessed value of real estate or mobile home as of March 1, current year: �� ��
� �., . ., � _
: �.j�C
The total annual adjusted gross income of this affiant when ,�c�itirtF�i6j� D d
his or her spouse for the prior calendar year, did not exc�d $10,000 and was
derived from the following sources and in the following amounts:
SOURCE OF INCOME
AMOUNT OF INCOME
$ �'6 0_ �9
-�.� . . . . . . . . . . . . . . . . . . . . . $33io, oa
TOTAL ...$
Were eit er you or your spouse required to file an income tax returra�
Yes�, No If yes, a copy of such return must be
inspection. '
�eding year?
�o��ounty auditor's
Other than a Mortga e Deduction, do you receive any other deductd f r �
�es No�. ��e �• ��
,ave you filed application for deduction in this county or any other count�/1J4e� , No�.
I swear under the penalty of perjury that the above and foregoing information is true and correct.
`See False Stateme Penalty Below. (0 eceipt) '.
.
11 �L'�r� �i� . ._ Y/.��� •
el� Address one No.
_� ;
On Behalf Ot (Owner's Full Name) � �i i _(Oviner's Complete Address)