HomeMy WebLinkAboutAge_Heiden{�0��00_�-0_Co �
�3�p����� AFFIDAVIT OF P SbN G5 YEARS OF AGE OR MORE
PrewibeC Oy Ne Smp �
Boa�E oi Ta. wmm�s�o�ers REQUESTING PROPERTY TAX DEDUCTION
TO BE FILED IN PERSON OR BY MAIL EACH YEAR WITH THE
COUNTY AUDITOR WHEqE 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�
_ (6-1.1-12-9 AND 61.1-12-10.1)
STATE OF INDIANA,
�
✓
, SS:
certify that I, (We) was/were
�years of age on the� . That I, (We) reside at
�0 � .� i°. �CCG�x+t�..�,1 , fit.-n.cut,.�.. , Township,
(SUeet or Rural Rou� (City or Town)
%�-�'�- 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:
'sa
value of real estate or mobile home as of March 1, cur ent year: ���n--'-ai �� .3 /8 a.
�.�.... _ a a..
The total annual adjusted gross income of this affiant when combined with that of
his or her spouse for the prior calendar year, did not exceed $10,000 and was
derived from the followUig�. so�� in the following amounts:
1�"� � �
SOURCE OF INCOME"` � AMOUNT OF INCOME
� �' APR 2 � j08B
.....................$
�' . o . ' � $
�' ..•�fTOR. - . . . . . . . . . . $
�"f o o —
TOTAL . . . $ �� � `
Were eit� 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?
Y�s No ✓ .
�!e you filed application for deduction in t+�is•cor�nty or any other county? Yes , No �
I swear under the penalty of perjury that the above and foregoing information is true and correct.
'See F Ise Stateme Penalty Below. (On Receipt) �
/oas � � ' �1 • ��.:
Filed Address � Phone No.
J
On Behalf Of: (Owner' Fu9 Name) � � (Owri_r's Complete Add�ess) _-�✓