HomeMy WebLinkAboutAge_LeGrangeFa�n 4] pevisea 19Bo
ResuiteE Uy me S�ate
Boaro ot Taz Lomnissioners
STATE
I, (We)
- AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE
REQUESTING PROPERTY TAX DEDUCTION n�
TO BE FILED IN PEfl50N OR BY MAIL EACH YEAP WITH THE 1
� �
COUNTY /UOITOH WHENE OWNEN'S GROGEPiY IS LOCATED� `J
RERL GNOGENTT - BEiWEEN MAPCH 1 AND MAY 10. INCLUSIVE ` /
MOBILE HOME - BETNEEN JANUAflY 1 r1NU MARLH Jl, INCLUSIVE /_ -_ �
�NOT ASSESSED AS HERL PPOGENTY) �
(E144].9 RND F1.14440.1)
� t i
lTY. SS:
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certify that I, (We) was/were
. Thaf I, (We) reside at
�SiREET OR flUFAI ROUTE)
❑ reat estate
0� ?Yt/Y1 ? � �'-�'� Township,
(QTV OR TOWN)
County, Indiana; t at I, (We) have owned the following described
j.
for 1(one) year or more prior to claiming this deduction, and That I, (We)
❑ mobile home
�
- • . �,
now reside in ihe premises for which this dedu,tion is claimed: _
� Surviving Spouse: If application is being made by a surviving unremarried spouse:
��� �� time of death:
Name on property .tax re�ords if different from above:
�� �v;r _ i: ,� I-{- �Q_,Q..c Nw� �O%�
�.gal Description or Key Number:
/� � � S
Assessed value o�f a Jp�QS(��sobile h,omne as of March 1, cu/r� nt year: n
.S _ . �L/ �, _ . /,/_.,�_ .,. // i. �—/79
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.
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�her than a Mortgage or Contract Deduction, do you receive any other deduction from property tax?
�s NO Have 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)
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