HomeMy WebLinkAboutAge_Ruckman- Porta 3D fleviSM 19BD
Preun�[d by t�e State
Boa�O of 7aa Commissiar.ers
�
STATE OF IN
AFFIDAYIT OF PERSON, 65 YEARS OF AGE OR MORE
REQUESTING PROPERTY TAX DEDUCTION
i0 BE FILED IN PEFSON OH BV MAIL EI.CN YEAN WITH THE
COUNTY AUDITOR WHERE OWNEP'S VNOiERTY IS LOCATED:
REAL PFOPERTY - BETWEEN MARCH t/ND MAY 10. INCWSNE
MOBILE MOME - BETWEEN JANUAPr 1 4ND MANCH Jt, INCWSIVE
(NOT ASSESSED AS REAL VROPERTY�
(E1.142.9 AND 61.1-12-10.1)
I, (We) ti
�years of age on�the �
Thaf I, (We) reside at
Township,
that I, (We) have owned the following described
for 1(one) year or more prior to claiming this deduction, and That I, (We)
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 nabove: -
� egal Description or Key Number: �• `�`�s- • "�
�sessed value of real estate or mobile home as of March 1, current year: �O '. �Q�O
' ��
Were either you or your spouse required to file an income tax return for ihe preceed' Y
No If yes, a copy of such return must be submitted for county auditor's p t n.
�///�• than a Mortgage r Contract Deduction, do you receive any other deduction from property tax?
/�� NO Have you filed application for deduction in this County o�� of]i$gQ�unty?
` 1 rvo �
�: swear under penalty of perjury that the above and foregoing information is true ��Qf�dG���s
'See False Statement Penalty Below. (On Receipt)