HomeMy WebLinkAboutAge_HelsleyFwm 773 BeviseJ 1�0
Prestti0ea Dy tne S�ate
BoarO oi la. Commissioners
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STATE OF IN
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LIJ real estate
❑ mobile home
AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE
REQUESTING PROPERTY TAX DEDUCTION
TO 8E FILEO IN PEPSON OH BY MAtL EACH YEAR WITH TME
COUNTY AUDITOF WHERE OWNEF'S PPOPENTY IS LOCATEO:
PEAL iROPENTY � BETWEEN MAFCN 1 AND MAY 10. INCLUSIVE
MOBILE HOME - BETVEEN JANUANY 1 ANO MANCH 3/. INCWSIVE '
(NOT ASSESSED RS REAI PPOVERTY).
COUNTY, SS:
l!
� � •
—, certify that 1, (We) was/were
. Thaf I, (We) reside at
Township,
(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 rom above:
�gal Description or Key Number: • �/" ,/� � � /� �� 2��J •/���'
yAssessed value of real estate or mobile home as of March 1, current year: �
43o-as�v
F�PR 1 1-1989 . �
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 ntract De chon, do you receive any other deduction from property tax?
::s NO Have you filed application for deduction in this County or any other county?
fes 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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