Age_Biel��sm' AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE
�°a`a °' T'• �°�"'"'"""' REQUESTING PROPERTY TAX DED�lGTION
TO BE FILED Iy RSON OR BY MAIL EACH YEAR WITH l HE
COUNTY AUDIT0�5�HERE OWNER'S PROPERTY IS LOCATED:
REAL PROPERTY BETWEEN - BETWEEN MARCFi 1 AND MAY 10 INCLUSIVE
�
STATE OF I N D
MOBILE MOME - BETWEEN JANUARY 1 AND MARCH 31, INCLUSIVE _—� /�.�
(NOT ASSESSED AS REAL PROPERTI� ���
' 6-1.1-12-9 AND 6-t.bi2-10.1) �. �����OJ
� �,� COUNTY, SS:
I, (We) .�i /�ih2� � '.C��.-L� , certify that I, (We) was/were
�years of age on the� I, (We) reside at
�0.5� Fc-a.l" ,�/�-Gu.a.-� �},�•, Q.�o-.�.-G Township,
(SVeet or Rural Route) (Cay or Town)
��..�� County, Indiana; that I, (We) have owned the following described
C% real estate for 1(one) year or more prior to claiming this deduction, and that I, (We) now reside in
C�7 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. ��-.�� � 7��0�' W�, �-� d
�,ssessed value of real estate or mobile home as of March 1, current year:
�
Were eith you or your spouse requireti {o�file @� income tax return for the preceeding year?
Yes�, No . If �y�s,� y of uch return must be submitted for county auditor's
inspection. AUDITOR
Other than a Mortga e Deduction, do you receive any other deduction from property tax?
•'es No_�.
�ave you filed application for deduction in this county or any other county? Yes , No_�_.
J
I swear under the penalty of perjury that the above and foregoing information is true and correct.
'See Fal atement Penalty Below. (On Receipt)
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Filed By'.�
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