HomeMy WebLinkAboutAge_PondFo.n 3zt Ae.ism tsso AFFIDAVIT OF PERSON� 65 YEARS OF AGE OR MORE -
kescnEd Uy �ne State
soam ot ra. commrssioners REQUESTING PROPERTY TAX DEDUCTION
TO BE FILED IN PEPSON ON BY MAIL E>CH YEIP WIiH THE O
COUNTY AUUITOF WHEFE OWNEF'S PPOVEPTY IS LOCATED:
FEAL PPOPEPTY - BETWEEN MARCH 1 ANO MAY 10. INClU51VE
MOBILE HOME - BETWEEN JANUARr 1 AND MAflCH ]t, INCWSIVE �
� (NOT ASSESSED AS REGL GROFERTY) _
� Q �, ._^_ \ (F1.142-9 AND 41.142.10.1) D/� i( J/ \��O— /� �
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STATE OF INDIANA, -�� "c'" "'`"' v COUNTY, SS:
I, (We) �`-<� , certify that I, (We) was/were
� S years of a e�on the � Thaf I, (We) reside at
� � �"C�<�G Township,
SJ TREE R RURA� ROUTE) (QTY OR TOWN� � �
`\ J
���-1 �� County, Indiana; that I, (We) have owned the following described
11Yreal estate
for 1(one) year or more prior to claiming this deduction, and That I, (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:
� _ �__ � _ _ � _ �.. . - _ .
Cegal Description or Key Number. J �'� �(� S`� �"
�sessed value of real estate or mobile Kome as of Maroh 1
current yeac o 30 — -1 �7�
Were ei ,��(�^',��J�°� u��e required to file an income tax return for the preceeding year? Yes
No ���"d`copy of such retum must be submitted for county auditor's.inspection.
Other 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?
s 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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