HomeMy WebLinkAboutAge_StricklandFarm ]Z3 Hevisea 19A0 AFFIDAVIT OF PERSON� 65 YEARS OF AGE OR MORE
PresrsiEW Oy ine Slaie
enara o� ra. cammusio�en REQUESTING PROPERTY TAX DEDUCTION
TO BE PILED M GENSON OP BY MAIL ERCH YEAR WITH THE �
COUNTY AUDITON WHEPE OWNEN'S PROGEPTY IS LOCnTED:
. RERL VqOVEHiY � BETWEEN MAHCH 1 AND MAY 10. INCLUSrvE
MOBiLE HOME - BETWEEN JANUARY 1 ANO MAHCH ]l, INCLUSIVE �/��
� � (NOT NSSESSED RS NEAL PPOPERTY)
(61.14]-9 ANp 61.141.10.1)
STATE OF INDIANA, �/C�J�C1� COUNTY, SS:
I, (We) �`%� �� �iiL�t9 , certify that I, (We) was/were
`� S years of age on the �! . Thaf I, (We) reside at
I' q!l/ �4V0�'JC�L119A'1 V � Township,
(STREET OR RUFAL ROUiE) (CITY OR TOWN)
County, Indiana; that I, (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 different from above:
Legal Description or Key Number: �"/ ,� 7— /�7�= /-c.x!.r //7 �i %r
�sessed value of real estate or mobile home as of March 1, current year:
Were either you or your s ouse required to file an income tax return for the preceeding year? Yes '
No If yes, a c py of uch return must be submitted for county auditor's inspection.
Other than a Mortgag o 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?
s NO -
I swear uniier penalty of perjury that the above and foregoing information is true and correct.
'See False Statement Penalty Below. (On Receipt)
Name)