HomeMy WebLinkAboutAge_GoddardFa�m m xe�sm �9eo AFFIDAVIT OF PERSON� 65 YEARS OF AGE OR MORE
Rewi0e0 Ey �ne S�aie
eoaro oi ra. commnsm�ers REQUESTING PROPERTY TAX DEDUCTION
� i0 BE FILE� IN PERSON OR BY MAIL EACH YEAP WITH THE
COUNTY RUOITON WHENE OWNEH'S PROPEPTY IS LOCATED:
HEAL PHOPEPTY - BETWEEN MARCM t AND MAY 10. INCLUSIVE
�
STATE OF INDIANA,
I�
MOBRE HOME � BETWEEN JAN114RY 1 RND MAFCM Il, INCWSIVE
(NOT /.SSESSED AS REAL PPOPEHTY)
(FiA4f-9 ANO 61.14240.1)
`4- � � V
���
COUNTY, SS:
certify that I, (We) was/were
� i
Thst I, (We) reside at
(\�� �
Q.O. c�. c� a9 `� C�e,,,,,n,�..�Sl,�,l, u ad� Township.
ISTREET OR PURAL iE) (CITV OR TOWN) � ,
County, Indiana; that I, (We) have owned the following described
�eal 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: �• ��"� '
�ssessed value of real estate or mobile home as of March 1
3� � y
current year:
�
�as
Were either ou or our s ouse re uired to file an income tax return for the rece 4� ar.
Y Y P 9 P �J Y���
No If yes, a copy of such_ retum must be submitted for county audito irF�,'p
Other than a Mortgage�r� Contract Deduciion, do you receive any other deducti �fr9 Rfj�,(� rty tax?
s NO �Have you filed application for deduction in this Count�r ah� dttt�Y county?
�s NO �
�xnc�i,�' m�.-s
I swear under penalty of perjury that the above and foregoing intormation is true and4H8TFEiDR
'See False Statement Penalty B�ow. (On Receipt)