HomeMy WebLinkAboutAge_McDowellFam 323 FevaeO 198t
Aesaioed M ine Sa�e
Boara ol Ta. Covuaasioners
�'
STATE OF INDIANA,
AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE
REQUESTING PROPERTY TAX DEDUCTION
TO BE FILED IN PERSON OR BY MAIL EACH VEAR WITH THE
COUNTY AUDITOR WFIERE 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 PROPERT� r//�J-J- R^�-�-�r
(&1.1-12-9 AND 6-1.1•12•10.1) {�.��= / — �
NTY, SS:
I, (�j � � , certify that I, �l4�e) was/were
�years of age on the�day of , 19�. That I, .(u+/e) reside at
Township,
treet or R ral Route) � (Ciry or Town)
Indiana; that I, (We) have owned the following described
Q" 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: �T N��Z ���% y / S-,.? ��� � 6 SG f�c
�ssessed value of real estate or mobile home as of March 1, current year. /"%� 2 r� —�3 �i�. D
Were eith�r 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?
Yes 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.
'See False Statement Penalty Below. (On Receipt)
� !Lf-�i r � ��o+..c�CiC/
Filetl By: Address \ '�' � �- "�! hone No.
T fC �i �
_ v
Oi: (Owner's Full Nan�e) �- (Owner's'Complete Address)