HomeMy WebLinkAboutAge_Collins_ j ` �� . — i � ({ _�!
Fam3aRe�eed�9Bi =.�. AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR RE
PrestiiDed M tlx Sta@
&iarG oi Ta. ������rs 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 70, INCLUSIVE
MOBILE HOME - BETWEEN JANUARY 1 AND MARCH 31, INCLUSIVE
(NOT ASSESSED AS REAL PROPERTI�
ATE OF INDIANA,
I --� I
(6-i.1-12-9 AND 6-1.1•12-10.1)
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CV/ G�
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3-y
NTY, SS:
that I, (We) was/were
v �.,���
. That I, (We) reside at
.v� Township,
(SVeet or Rural Route) � (Cny or iown)
County, Indiana; that I, (We) h�ve o ned the following described
real estate for 1 one ear or more rior to ciaimin this deduction, and that I,
❑ mobile home � � Y p 9 (We) now reside in
the premises for which this deduction is claimed:
Surviving Spouse: If appiication is being made by surviving unremarried spouse:
Spouse's age at the time of death:
Name of property tax records if different from
Legai Description or Key Number: P� �� � g- I'I� S��
,�
value of real estate or mobile home as of March 1,
—77m :
The total annual adjusted �ross income of this affiant when combined with that of
his or her spouse for the prior calendar year, did not exceed $10,000 and was
derived from the following sources and in the following amounts:
SOURCE OF INCOME
AMOUNT OF INCOME
-�_��•- . �_ ..._ � ��
$
$
....................._
TOTAL ...$
Were eit er you or yo�saouse required to file an income tax return for the preceeding year?
Yes , No If ; a copy of such return must be submitted for county auditor's
inspection.
OeSer than a Nor�g ed�o� you receive any other deduction from property tax?
o�
Have you filed applic tion for deduction in this county or any other county? Yes , No .
f�1NY 3 1985
'swear undec�he penalty of peyury that the above and foregoing information is true and correct.
See False St��� (On Receipt)
i
AUDITOR '
Filed By: Address Phone No.
,�
� y��P ���
On e alf Of: (Owner' ull Name)
e
(Owner's Complete Address)