Age_SchwomeyerForm 3Zi Fevise0 1980
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BOdlC 0� id� COIMII5510(IClS
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� mobile home
AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE
RE�UESTING PROPERTY TAX DEDUCTION
TO BE FILED IN PENSON ON BY MAIL EACH YEAP WITX THE
" COUNT'I AUDITOR WHENE OWNEN'S �POGENTY IS IOCATEO:
PEAL FHOPEflTY - BEiWEEN MANCH 1 RND MAY 10. INCLUSIVE
MOBILE HOME - BETWEEN JANUAHY 1 ANO MANCH ll, INCLUSIVE
(NOT ASSESSED /5 REAI PNOVEPTY)
Indiana; that I
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certify that I, (We) was/were
Thaf I, (We) reside at
Townsh i p,
the following 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 spouse:
Spouse's age at time of death:
Name on property tax records if different from above:
�gal Description or Key Number: � �
Hssessed value of real estate or mobile home as of March 1, current year:
—
Were either you or your 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 auditors inspection.
Other than a Mortgage r Contr Deduction, do you , receive any other deduction from property tax?
, NO ave you filed application for deduction in this County or any other county?
�3 N O . .
I swear under penalty of perjury that the above and foregoin9 information is true and correct.
�.See False Statement Penalty Below. (On Receipt)
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