HomeMy WebLinkAboutAge_MillerFo�� m Re�sea iso AFFIDAVIT OF PERSON� 65 YEARS OF AGE OR MORE -
Prescri0ea q� roe Stare '
BoarE a� Ta. w��ss�e�s REQUESTING PROPERTY TAX DEDUCTION "
TO 6E FILED IN PENSON OP BY MGIL ERCH YEAP WITH THE /��/
COUNTY /.UOITOP WHERE OWNEP'S PPOVEPTY IS LOCATED:
FEAL PNOPENTY - BETWEEN MANCH 1 ANO MAY 10. INCLUSIVE
MOBI�E HOME - BETWEEN JANUAFY 1 AND MAHCH Il, INCLUSIVE
(NOT FSSESSE� AS NERL PROGENTY) /�
� (6-t.14f-9 AND 61.142-10.1) � A /�74
rC P
STATE OF INDIANA, /./�-u-a%'�'�- COUNTY, SS:
(We)
certify that I, (We) was/were
r
�years of age on the �� . Thaf I, (We) reside at
(STREET Ofl RUF flOUTE� � (CIiY OF TO'� wN� ' Township,
County, Indiana; that 1, (We) have owned the following described
.
� 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 differenj, from above:
� egal Description or Key Number: �� � x-� •/
,sessed value of real 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
— S43a
AMOUNT OF INCOME
,�1. G. � --�� ......................5
�r;f;l; � 1'?82
_ . . . ,.� . . . . . s
�. •O�Al1Di71)R. . S o7b o o. o0
�?r2�1� .......
TOTAL..S aO00. OD
Were either you or your spouse required to file an income tax return for the preceeding year? Yes
No�Q—. If yes, a copy of such retum must be submitted for counry auditor's inspection.
�ther than a Mortgage or Contract Deduction, do you receive any other deduction from property tax?
s NO � Have you filed application for deduction in this County or any other county?
NO �°
I swear under penalty of perjury that the above and foregoing information is true and correct. �
'See False Statement Penalty Below. (On Receipt) ,_
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