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AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE
REQUESTING PROPERTY TAX DEDUCTION
TO BE FILED IN PERSON OR BY MAII EACH YEAR WITH THE
COUNTY AUDITOR WHERE OWNER'S PROPERTY IS LOCATED:
REAL PROPERTY BETWEEN - BETWEEN MARCH 1 AND MAY 10, INCLUSIVE
MOBILE liOME - BETWEEN JANUARY 1 AND MARCH 31, INCLUSIVE
(NOT ASSESSED AS REAL PROPERTI�
(&1.1-12-9 AND &1.1-12-10.1)
��
STATE OF INDIANA, �-�� COUNTY, SS:
c
certify that I, (We) was/were
� S years of age on the � �� . That I, (We) reside at
'7 3 / 7r� �� ,G.E ,' , �La-r,G..^-�- ,
(Street or Rural Route� '(City oi Town)
Township,
/.�u+o*� � County, Indiana; that I, (We) have owned the following described
�J reai estate for 1(one) year or more prior to`claiming this deduction, and that I, (We) now reside in
❑ mobile home
the premises for which this deduction is claimed:
Surviving Spouse: li application is being made by surviving unremarried speuse:
Spouse's age at the time offdeath:
t
Name of proper� tax records if different from
Legal Description or Key Number:
value of real estate or mobile home
�
an income tax ieturn for the
such return must be subm
any other deduction from prope
county or any other county?
e above and foregoing information is true
Receipt)
Address
�
.�
� �
�g year?
county auditor's
tax?
—, No x .
nd correct. '