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AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE
REQUESTING PROPERTY TAX DEDUCTION
TO BE FILED IN PEFSON OR BY Ml.11 EACH YEAR WITH THE
COUNTY AUDITOH WNENE OWNEP'S PNOVEPTY IS LOCI.TED:
REAL PPOPENTY - BETWEEN MRRCH 1 AND MAY 10. INCLUSIVE
MOBILE MOME � BEiWEEN JANIIARY t RND MAHCN ]l, INCLUSIVE
(NOT ASSESSED AS RE/.L VHOVERTY)
�/ �, _ �
that I. (We) was/were
Indiana; that I, (We) have owned
I, (We) reside at
Township,
lowing 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 spoyse:
Spouse's age at time of death:
Name on property [ax records if
�`gal Description or Key Number
.,�sessed value oi real estate or mobile home as of March 1
current year:
�
Were either you or your spou _G���ncome tax return for the preceeding.year? Yes�
No If yes, a copy of su ust be submitied for'county auditor's inspection.
Other than a Mortgag or Co ct Deduction, do you receive any other deduction from property tax?
s NO Have you filed application for deduction in this Couniy or any other county?
es NO �
.�
I swear under penalty of perjury that the above and foregoing information is true and correct.
'See False Statement Penalty Below. (On Receipt)
y
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