HomeMy WebLinkAboutAge_HopperFarm 323 fleviseE 1980
Presafoea M me staie
Baara ot Ta. Commissianers
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1S
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STATE OF INDIANA,
AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE
REQUESTING PROPERTY TAX DEDUCTION � n/��
TO BE FILED IN FERSON ON BY MAIL EACH YEAR WITH THE �0�
COUNtY AUOITOP WHEFE OWNER'S PROiERTY IS LOCAiED:
PEAL PPOiEPTY - BETWEEN MARCH 1 AND M/Y 10. INCWSIVE
MOBILE HOME - BETWEEN JANUANY 1/.ND MANCH Jl, INCLUSIVE
(NOT ASSESSED AS REAL PHOPERTY�
(EfA42-9 AND 61.1d240.1)
COUNTY. SS:
I, (We) �`-^�-'�'"—� •� Lw�� � , certify that I, (We) was/were
`� years of age on the � � �: ThaE.l, (We) reside at
53 ��•�1� ��1-�-�M- lit.(1LXi-✓v�t� l�-U_ Township,
(STflEET Ofl fl' 'ROUI^TE) �CITY OR TOW�'
��/�.�+�^-' County, indiana; that I, (We) have owned the following described
�eal 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 differanf trnm ahnva
gal Description or Key Number:
��
Assessed value of reai estate or mobile home as of March 1
current year:
The total annual gross income of this affiant when combined with that of his or
her spouse for the prior calendar year, without any deductions, did not exceed
571,000 and was derived from the following sources and in the following
amounts: '
SOURCE OF INCOME AMOUNT OF INCOME
�� ............................. S 3 a � �-�-s
��� .............................s asq i. 39
P.��- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S a � � c� � i a
TOTAL..S 6 S`f'O . `i l0
Were�h�r o�bp��pouse required to fiie an income tax retum for the preceeding,year? Yes '�
No �Tje's, a copy of such retum must be submitied for county auditor's inspection.
nther tFYgPl�anMtottg��ge or Contract Deduction, do you receive any other deduction from properry tax?
�s NO '� Have you .filed application tor deduction in this County or any other county?
._as���-
"R 0
I swear under penalty of perjury that the above and foregoing information is true and correct.
'See False Statement Penalty Below. (On Receipt) '
v�. . � . �
�Owner's Full�ame) /� .c� � YL✓L�'+ IOwner's ComWete Aaoressl
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