HomeMy WebLinkAboutAge_WolfeForm 3Zi BeviseJ 19fi0
Presni�M M me s�z�e
BoarE ol Ta� Commissimees
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AFFIDAVIT OF'PERSON, 65 YEARS OF AGE OR MORE
REQUESTING PROPERTY TAX DEDUCTION
TO BE FILED IN FERSON.OR BY M41L EACH YEAF WITH THE
COUNiY AUDITON WNERE OWNEN'S PROGERTY IS lOC>TED:.
NEAL PROPEPTY - BETWEEN MANCH 1 ANp MAY 10. INCWSIVE
MOBILE HOME - BETWEEN JANU/.NY 1 AND MApCH 3/. INCLUSIVE
(HOT ASSESSED AS NEAL PNOPEPTY)
(G1.142.9 PND 61.14140.1)
STATE OF INDIANA, ,., 4-��K-� COUNTY, SS:
I, (We) � -��v , certify that I, (We) was/were
�years of age on the �-? That I, (We) reside at
f22.�-I C S I _`�.� �
Township,
(STREET OR R AL ROUTp1 � (CI fl TOWN)
� /1 1
���-+^��A�� County, Indiana; that I, (We) have owned the following described
J� real estate
for 1(one) year or more prior to claiming this deduction, and That 1, (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:
Spouse's age at time of death:
Name on property tax records if different from above:
Legal Description or Key Number: P r- �. Q• Ul �—�'�D 3� ��-
�sessed value of real estate or mobile home as of March 1, current year: �(0 7� `��7D =
The total annuai gross income of this affiant when combined with that of his or
her spouse for the prior calendar year, without any deductions, did not exceed
S71,000 and was derived from the following sources and in the following
amounts:
SOURCE OF INCOME
AMOUNT OF INCOME
o h o �- - . . . . : . . .. . . . . . . . . . . . . . . . . . . . . 5 a y (� . � 7
I�,�..�.� . . . . . ., . . . . . . . ; . : . . . . . . . . . . . . S 3 � (o , a �j
............................ s
TOTAL..S (� 3 a . � (� � °
Were eiiher you-or�,��ur spouse required to file an income tax retum for the preceeding year? Yes �
No��� �% %� If,�yes, a) copy of such return. must be submitted for county auditor's inspection.
r� c".r'�1JL��1L -
Other than a MorQgage ol Contract Deduction, do you receive any other deduction from property tax?
�as �Y�. �}�tC�.;�Have you filed�pplication for deduction in this County or any other county.
;�s NO � :
v��LP/ it� �2GS� � S ..
I swear under �penal�y of perjury that the above and foregoing information is true and correct.
R...,, . J�.
'See False Statement Penalty Below. (On Receipt)