HomeMy WebLinkAboutAge_Wallace (3)Fwn 3Z! Pev¢eE 19A0
Resui� Uy I�e Stau
Baa�a oi ia. Cammrssioners
�
STATE OF INDIANA,
�, (We) v�L�' 1 UJv
��years of
�2
�STREET OR flU 4 PpUTE��
estate
❑ mobile home
AFFIDAVIT OF PEfl�� �5 Y � AGE OR MORE
REQUESTING PROPERTY TAX DEDUCTION
TO BE FILED IN PENSON OP BY M41L EACH YEAR WITH THE
COUNTY AUOITON WHEHE OWNEH'S VPOPENTY IS IOCATED:
FE/L PROPERTY - BETWEEN M4NCH 1 ANO MAV 10. INCWSrvE
MOB�LE HOME - BETWEEN JANUARI' 1 AND MARCH ]t, INCWSIVE
(NOT ASSESSED AS NEAL PFOPENTY)
on the
- (�14-1Y-9 AND 61.t4240.1) � /__ Z3-�-� - z o� � � - o �°� -ba`�
{�,
COUNTY, SS:
� /1 • d A . i� l . � _ /1 � e
TOWN)
nty, Indiana; that I, (We)
that I, (We) was/were
Thaf I� (We) reside at
Township,
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 rnade by a surviving unremarried spouse:
Spouse's age at time of death:
Name on property tax records if dif from above: �/�
' �gal Descrip[ion or Key Number: �, � ' � `I °`' / / � +l'[ L
�ASSessed value of real estate or mobile home as of March 1, current year:
A
7v6'y!, s_ �
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
S11,000 and was derived from the following sources and in the-following
amounts:
SOURCE OF INCOME
AMOUNT OF INCOME
`� � _ �����.�.......5 � s�'�.��
� � /rg�•
� � . . . ...:............ S
....MA� o � 19a�
. ..... .............
........5 ax6z.: --
yy���� . z qi-:
�L°"D �" ��i 0"R Q IOTAL..S '2(1�-
' � ` c.� �. ,.
Were either you or your spouse required to file an income tax return for ihe preceeding year? Yes �
No If yes, a copy of such return must be submitted for county audito'r,'s�inspeCtion.
Other than a Mortgage r Con Deduction, do you receive any other deduction from property tax?
�s NO ave you filed application for deduction in this County or any other county?
., es NO
I swear under penalty of perjury that the above and foregoing information is true and correct.
'See False Statement Penalty Below. (On Receipt)