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Form 37� Revise0 t980 AFFIDAVIT OF PERSON� 65 YEARS OF AGE OR MORE
ReS�eipN py Ihe State
soxm oi rz. co�rss+o�ns REQUESTING PROPERTY TAX DEDUCTION
�
TO BE FILEO IN PENSON ON BY MAIL EACH YEAR WITH THE
COUNTY RUOITON WHENE OWNEN'S �NOVENTY IS LOCATEO:
� NEAL VNOFENiY - BETWEEN M/PCH 1 ANp MAY 10. INCWSIVE
M08ILE MOME - BETNEEN JANUAflY 1 AND MANCM 7t, INCLUSIVE
(NOT ASSESSED RS�NEAL PPOPEPTY)
(61.14]-9 /NO F1.14240.1)
STATE OF INDIANA, _.1�11, �-�/!? COUNTY, SS:
I, (We) 1_1,i71-)'u�1 n 1 �y
�years of age on the
(STREEi OR RURAL ROUTE)
� I
cert� that I, (We) was/were
'�. Thaf I, (We) reside at
Township,
County, Indiana; [hat I, (We) have owned the following described
real estate
for 1(one) year or more prior to claiming this deduction, and That I, (We)
❑ mobile home � �
now reside in the premises for which this deduction is claimed:
Surviving Spouse: If application is being made by a surviving-unremarried spouse:
Spou�s,e�''s� age at time of death: -
Name o�rp �� tecdrds if different from above:
����� 1 —7 �/
gal Descriptio or �� Number: �L N.SL� �y� �I4 �(—��� I -/�. 1� L
� f;4AY � 3 l�b� '71 30 — 3.9 %0
Assessed value of real estate or mobile home as of March 1, current year:
u/nx(� �' Y�U��s �
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.
'�Er than a Mortgag�or ntract Deduction, do you receive any other deduction from property tax?
� NO Have you filed application for deduction in this County or any other county?
,Yes NO � , . •
I swear under penalty of perjury that the above and foregoing intormation is true and correct.
'See False Statement Penalty Below. (On Receipi)
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