HomeMy WebLinkAboutAge_Anderson`"""""�`�`°'�' AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE
PreSUibetl by Ne S��e
B°"° °"°' `°'""���1ef5 REQUESTING PROPERTY TAX DEDUCTION
TO BE FILED IN PERSON OR BY MAIL EACH YEAR WITH THE
-' COUNTV AUDITOR WHERE OWNER'S PROPERTV IS LOCATED:
� REAL PROPERTY BETWEEN - BETWEEN MARCH 1 AND MAY 10, INCWSIVE
� MOBILE HOME - BETWEEN JANUARY 1 AND MARCH 31, INCLUSIVE
(NOT ASSESSED AS REAL PROPERTY)
�TATE OF INDIANA,
�
(6-iJ-12-9 AND bt.t-12-10.1)
�
OOO�/ �
a9-3
NTY, SS:
certify that I, (We) was/were
�
�. That I, (We) reside at
� / 5 � . � , ��� , Township,
(S[reei or Rural Route) (CUy or Town)
�L"L..L�oer� County, Indiana; that I, (We) have owned the following described
�1 real estate for 1(one) year or more prior to claiming this deduction, and that I, (We) now reside in
❑ mobile home
the premises for which this deduction is claimed:
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:
_ Assessed value of real estate or mobile home as of March 1, current year: �D ^-��= _ 3 �/D .
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 $10,000 and was
derived from the following sources and in the following amounts:
SOURCEOFINCOME
AMOUNTOFINCOME
,a a. .....................$ �
.�n�F . _ _ a�.� . . . . . . . . . . . . $ 5G 3 9. 5 9
$ �.
AA,-, � � 6 �1985 . . . . . . . . . . . . . . . .
.�, �.�
AUDITOR
GIBSON COUNTY
TOTAL . . . $ � �'� g �/ %
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 Mortga�Deduction, do you receive any other deduction from property tax?
Yes No . ' �
Have you filed application for deduction in this county or any other county? Yes , No �
�ear under the penalty of perjury that the above and foregoing information is true and correct. �
�ee False Statement Penalty Below. (On Receipt)
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F�io.+ A, Addresz Phone No_