Age_Tucker'Fam 323 flavsetl 198t
PrexnOeC by Ne Siax
BaarU al TaR Commissioners
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AFFIDAVIT OF. PERSON, 65 YEARS OF AG� GR MORE
REQUESTING PROPERTY TAX DEDUCTION
TO BE FILED IN PERSON OR BY MAIL EACFi YEAR WITH THE
COUNTY AUDITOR WHERE 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•&1.1•12-10.1)
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STATE OF I I NA, . ���1 COUNTY, SS:
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I, (We) � � �� �L� a�4 � l�-��- , certify that I, (We) was/were
I , �
�1�Lyears of age on the�� I, (We) reside at
, � R 3 , P � `�i _Township,
(SVeet or Rural Route) (City or iown)
`�,Q.�pr✓Y� County, Indiana; that I, (We) have owned the foilowing described
B' 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:
�e
�ssessed value of real estate or mobile home as of March 1, current year:
...$ '
Were ither 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 Mortgag�Deduction, do you receive any other deduction from property tax?
�Yes No \
riave 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 foregoir in�jr���, r and correct.
'See False Statement Penalty elow. (On Receipt)
. I;�q�, 4 1°�3
F� By:� Address � Phone No.
,
,`�� � AUDITOR �
,
On Behalf Ot: (Owner's-Full Name)-- � (Owner's Complete Address)
. 1 . � , . _ — �—'�� 1� . ' _
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