HomeMy WebLinkAboutAge_Thorne�
Fa�en 323 Pevsetl 1981
Prexn�etl by Ne Sta�e
BoarE al Ta� CocunosionUs
�
STATE OF INDIANA,
AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE
REQUESTING PROPERTY TAX DEDUCTION
TO BE FILED IN PERSON OR BV MAIL EACH YEAR WITH THE �
COUNTY AUDITOR WHERE OWNER'S PROPERTY IS LOCATED:
REAL PROPERTV BETWEEN - BETWEEN MARCH 1 AND MAY 10, INCLUSIVE
MOBILE HOME - BETWEEN JANUARY 1 AND MARCH 31, INCLUSIVE
(NOT ASSESSED AS REAL PROPERTI��
(61 1-12-9 AND 6-1.7-12-10.1)
,��,u, .�, l
/ �
ss:
I, (We) //.P_l�Xc�- ���ic.e-- , certify that I, (We) was/were
�years of age on �That I, (We) reside at
.d-o-*G /�� , ��d�,�.. _ ��=n-ctrrC�TOwnship,
(SVeet or Rural Route) (CRy or Town)
;,CL�-¢-�-y" County, Indiana; that I, ) have owned the followin described
�1 real estate � �O �� y - a5"�v � �G �� ��""'
❑ mobile home for 1(one) year or more prior to claiming this deduc' , a that I, (We) now resid in
� � . _ _ �)
the premises for which
�l � ��
is c aimed:
Surviving Spouse: If application is being made by surviving u
Spouse's age at the time of death: �
Name of property tax records if different from
Legal Description or Key Number:
spouse:
value of real estate or mobile home as of March 1, current year: —
The total annual adjusted gross income of this affiant when combined with that of
his or her spouse for the prior calendar year, did not exceed $10,000 and was
derived from the following sources and in the following amounts:
RCE OF INCOME
AMOUNT OF INCOME
_ $ _
L .....................$ 9a��..� 7
,��-,+,� . . . . . . . . . . . . . . . . . . . . $ v? b � . G %
TOTAL . . . $ �I � SS D . � J�
�
Were eit er you or uo r,s ouse required to file an income tax return for the preceeding year?
Yes�, No ��. llf2v�86a copy of such return must be submitted for county auditor's
inspection. .�'
d�J,
Other than a Mortg e i do;you receive any other deduction from property tax?
Yes No �^�T p �
��lave you filed application for deduction in this county or any other county? Yes , No�.
� swear under the penaity of perjury that the above and foregoing information is true and correct.
'See False Statement Penalty Below. (On Receipt)
�' �cLL.� �,.� _ � ��.J� �i.t-���v-�-cc� � .
Filed By: Address '/� Phone No.
IOn Behalf OC (Owner's.Full Name) (Owner's Complete Address) �
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