HomeMy WebLinkAboutAge_Marshalleo�m m ee.�sm i5eo AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE
RescriAeE try I�e Slate
e�am oi ra. camm�ssi�u: REQUESTING PROPERTY TAX DEDUCTION
TO BE FIlEO IN PEPSON Ofl BY MAIL EACH YEAH WITN THE
COUNTY AUOITOR WMEFE OWNEF'S PHOFENTY IS LOC/TED:
\ HEAL PROPERTY � BEiWEEN MAPCH 1 ANU MAY 10. INCWSIVE
_—�f� MOBILE MOME - BETWEEN JANUAflY 1 AND MARCM Ot. INCWSIVE
� (NOT ASSESSEU A$ flEAI PPO�EPTY) .
(41.14]-9 ANO 61.14240.1)
STATE OF INDIANA, ����¢J7 COUNTY, SS:
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certify that I, (We) was/were
—. Thaf I, (We) reside at
Township,
County, Indiana; that I, (We) have owned the following described
t,p real 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 irom above:
Legal Description or Key Number. _��T -� �- h"
i�
�sessed value of real estate or mobile home as of March
1, current year: ��
g�o-ao3o_
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
511,000 and was derived from the following sources and in the following
amounts:
SOURCE OF INCOME
AMOUNT OF INCOME
�� .............................5
� �i.� - � !�%
/ �t TL NG�/, ..............:.��........... S .�4 --�d . D �
�aXAsb�P� /�Li'/� iYi�J�OV�iiIP�� ! TOTAL..S� d�. D 7%
/
Were either you or your spouse requi tax return for the preceeding year? Yes_J�._
No If yes, a copy of such u�i u itted for county auditor's inspection. �
Other than a Mortg�a� e or Contract Deductio �$ you receive any other deduction trom property tax?
"°s NO ,�_ Have yo��daa�p��i39on for deduction in this County or any other county?
�s "� NO' � .
� � �s
1 swear under penalty of perjury that Ihe/���n oregoing information is true and correct.
'See False Statement Penalty Below. (On Receipt) -� .
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