HomeMy WebLinkAboutAge_LeflerFwm323ReJseEf981 AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE
PresriEed by Ne Stare
Boaea al ia. Cownkamers REQUESTING PROPERTY TAX DEDUCTION �
TO BE FILED IN PERSON OR BY MAIL EACH YEAR WITH THE
COUNTY AUDITOR WHERE OWNER'S PROPERTY IS LOCATED:
REAL PROPERTY BETWEEN - BETWEEN MARCH 1 AND MAY 10, INCLUSIVE
�
STATE OF INDIANA,
�
of
MOBILE HOME - BETWEEN JANUARY 1 AND MARCH 31, INCLUSIVE
� (NOT ASSESSED AS REAL PROPERTI� _ _ —
(61.1-12-9 AND 61.1-12•10.1)
the�
. That I, (We) reside at
�f/YI�.�T' Township,
-' �( Veet or Rural Route) (Ciry or Town) r�
� —�-�
P� 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 suryiving unremarried spouse:
Spouse's age at the time of death:
Name of property tax records if differget from
Legal Description or Key
-3-�n �o� —��,��1
value of real estate or mobile home as of March 1, current year:
� 3-i
Were either u or your spouse require to file an income tax return for the preceeding year?
Yes , No . If yes, a�ep�c,m€�Gc�E�fi must be submitted for county auditor's
inspec on. - AUDiTOR
OeSer than a No�rtgage uction, do you receive any other deduction from property tax?
_�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)
, 5.,.� 6 __���_ � . � oZ ���iziro�� � /�7(� f�2
.. ,
Fil d B. � a Ad ress �� Phone No.
On Behalf Of: (OwneYs Full Name) � (Owner's Complete Address)