HomeMy WebLinkAboutAge_BellFOrtn 3�3 flev"sen 1981
Presn��'s'.Sy Ne Sa�
Boa�E ol iaa Cor,unissioners
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AFfIDAVIT OF P�O , 6�5 YEAR�� S OF AGE OR MORE
REQUESTING PROPERTY TAX DEDUCTION
TO BE FILED IN PERSON OR BY MAIL EACH YEAR WITH THE
COUNTY AUDITOR WHERE OWNER'S PROPERTY IS LOCATED:
REAL PROPER�Y BETWEEN - BETWEEN MARCH 1 AND MAY 10, INCLUSIVE
MOBILE HOME • BETWEEN ilANUARY i AND MARCH 37, INCLUSIVE
� (NOT ASSESSED AS REAL PROPERTI�
�
(61.142-9 AND 61.142-10.1)
� 3
STATE OF INDIANA, �'1���VXJC/�"� COUNTY, SS:
. .. — . �-
I, (We) �� C7�/Y`(�.c��,_�'(� ��ASCSL- r{. NF�xC�.l7�.a certify that I, (We) was/were
(n (n years of age on the� . That I, (We) reside at
� ��C�QJ", , ��`�/YIAA"(1 Township,
(SVeet or Rural Route) (City or Town)
��la-xJ�w'�� 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) 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 from above: _ __ �; `�% � .
Legal Description or Key Number:�,l�� I LlT' �`I �..l..�T� l`-I I J-`'L
�ssessed value of real estate or mobile home a$ qf March 1, current year: �
/�030- /n��n
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
inspection.
Other than a Mortgage Deduction, do you receive any other deduction from property tax?
es No
..�ave you filed application for deduction in this county or any other county? Yes , No .
I swear under the penalty of perjury that the above and foregoing information is true and correct. �:J
`See False Statement Penalty Below. (On Receipt) �
/ ,,,, ,..�. 7�. /�p�
F'� By: Address Phone No.
� i r
On Behalf Of: (Owner's Fur Name) } � (Owner's Complete Address) �