HomeMy WebLinkAboutAge_NultonFwm 323 fiens�tl 1991
Prescribed by Ne $Ia@
Boara oi Ta. Comtaissioners
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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 YEAR WITH THE
COUNTY AUDITOR WHERE OWNER'S PROPERTY IS LOCATED:
REAL PROPERTY BETWEEN • BETWEEN MARCM 1 AND MAY 10, INCLUSI E
MOBILE HOME • BETWEEN JANUARY 1 AND MARCH 31, INCLUSIVE
(NOT ASSESSED AS REAL PROPERTI�
(&1.1•12•9 AND 6-1.1-12-10.7)
STATE OF INDIANA, COUNTY, SS:
I, (We) �*�. V� . °I- .�an� � • �l �s*�' , certify that I, (We) was/were
(° � years of age on the '�. That I, ide at
Q•� • �Lia'�. �� , �y^ • , o'c` T ship,
(SVeet or Rural Route) (Ciry or Town)
�" County, Indiana; that I, (We) have owned the following described
❑ real estate for 1(one) year or more rior to claiming this ded ction, an at I, (We) now eside in
C�riiobile home
the premises for which this eduction is claimedC� " l �— �' Q�
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Surviving Spouse: If application is being made by surviving unremarried spouse:
Spouse's age at the time of death:
Name of property tax records if different from above:
Legal Description or Key Number: ,�Q � '- '9"�" �`+�---
�ssessed value of real estate or mobile home as of March 1, current year: s 40n•
,
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 ,auditor's
inspection.
Other than a Mortgag Deduction; do you receive any other deduction from property tax?
�es No�. /
ave 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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Filed By.�� - Address Phone No.
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On Behalt OE (Owners Full Name) j - ,( (Owner's Complete Address� - --�