HomeMy WebLinkAboutAge_CattPorm 3U flevise0 1980
Fescri�eE Uy t�? State
Boara of ia. Commissioners
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STATE
AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE
RE�UESTING PROPERTY TAX DEDUCTION
TO BE FILED IN VERSON OR BY MAIL EACH YEAP WITN THE
COUNTY AUDITON WHEPE OWNER'S VpOVENTY IS LOCAiED:
flEAL VROGERTY - BETWEEN MARCH 1 AND MAY 10, INCWSIVE -
MOBILE HOME - BETWEEN JANIIAPY 1 RND MAHCM ]l, IHCLIISIVE
(NOT RSSESSED AS HE/.L GNOPENTY�
(61.14&9 AND F1.14240.1) '
age on the �
Q.Q.i
(ST(iEET OR RUR .f�t ROUTEI (CIT OR TOWN)
V%I. 0.. �>
J���� County
$ real estate
❑ mobile home
COUNTY, SS:
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(We) was/were
Thaf I, (We) reside at
Township,
Indiana; that I, (We) have owned the tollowing described
for 1(one) year or more prior to claiming this deduction, and That I, (We)
now reside in the remises for which this deduction is claimed:
Surviving Spouse: It application is being made by a surviving unremarried spouse:
Spouse's age at time of death:J ��
Name on property tax records if different from above: �"����
� ��. �'tD I� I-lo ��ini2619�9
,�gal Descrip[ion or Key Number:
�•+ �
Assessed value of real estate or mobile home as of Maroh 1, current year. �57���'230 +�����
.:.. ,� .
_ . AUDITOrZ
The total annual gross income of this affiant when combined with that of his or
her spouse for the prior calendar yeai, without any deductions, did not exceed
511,000 and was derived from the following sources and in the following
amounts: -
SOURCE OF INCOME -' AMOUNT OF INCOME
. ............................. s a98'1.�
' . . . . . . . . . . . . . . . . . . . . . . . . . . . . . s 39 �f s.ao ,
�w,,�. �..►- ............................. s IIqS.eo
���� TOTAL..S �a1.�r;"-.
Were either 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.
� �er than a Mortgag r Contrac uction, do you receive any other deduction from property tax?
` NO ve you filed application for deduction in this County or any other county?
— Yes NO
I swear under penalty of perjury that the above and foregoing information is true and correct. .
'See False Statement Penalty Below. (On Receipt) �(1
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