HomeMy WebLinkAboutAge_Martin (2)Form 323 fleJSetl 1981
Re2ripsf py Ne Sta@
BoarU ot Ta. Lomm¢sioners
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AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE
REQUESTING'PROPERTY TAX DEDUCTION
TO BE FILED IN PERSON OR BY MAIL EACH VEAR WITH THE
COUNTV AUDITOR WHERE OWNER'S PROPERTY IS LOCATED:
REAL PROPERTV BETWEEN - BETWEEN MARCH 1 AND MAY 10, INCLUSIVE
MOBILE HOME - BETWEEN JANUARY t AND MARCH 31, INCLUSIVE
� (NOT ASSESSED AS REAL PROPERT�
. (6-1.1-72-9 AND 6-1.1-12•10.1)
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STATE OF INl}(A YAe, COUNTY, SS:
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I, (We) , certify that I, (We) was/were
�ears of a e on the
�. That I, (We) reside at
3 � ! Township,
(Street or Rural Rou�e) ( rt or Town)
:�LUC}�'� County, Indiana; that I, (We) have owned the foltowing described
�real estate for 1(one ear� QPrior to claiming this d uction, and thai I, (We) now reside in
❑ mobile home
the premises for which t is deduction i�tyt2im"e�.� �� �� �zp
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Surviving Spouse: If appiication is being made by surviving unremarried spouse: /
Spouse's age at the Ume of death: ��
Name of property tax records if different from
Legal Description or Key Number:
value of real estate or mobile home as of March 1, current year:
The total annual adjusted gross income of this affiant when combined with that of
his or her spouse for the prior calendar year, did not exceed $10,000 and was
derived from the following sources and in the following amounts:
SOURCEOFINCOME
AMOUNT OF INCOME
�8 0� _ . . . . . . . . . . . . . . . . . . . . . $ _
.�� .`� !� . . . . . . . . . . . $
�.`� . .
..- ................... $
� :: : r' � i927
\: TOTAL .. $
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A UDI-ri� �z�'�i
Were either you or y�r 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.
Other than a Mortga e Deduction, do you receive any other deduction from property tax? ,
�es No
iave you filed application for deduction in this county or any other county? Yes , No
I swear under the penalty of perjury that the above and foregoing information is true and correct. �'
'See False Statement Penalty Below. (On Receipt) '
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nddress
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Phone No.