HomeMy WebLinkAboutAge_BrightFwm 3Li Revnxa 1980
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- �o�y I
AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE
RE�UESTING PROPERTY TAX DEDUCTION
�0 BE FILED IN PERSON ON BY MAIL ERCH YEI.N WIiH THE
COUNTY AUOITOH WHERE OWNER'S PROiEPTY IS LOCATED:
REAL PRO�ERTY - BETWEEN MARCH 1 AND MAY 10, INCLUSIVE
r
MOBILE HOME - BETWEEN JANURRY 1 AND MANCH Il, INCLUSIVE
(NOT ASSESSED AS REAL PNOPEFTY)
(E1.142.9 AND 61.14T40.1)
STATE INDIANA, lVN(J'"°'— COUNTY, SS:
I, (W °F `�-t'6"°' , certify that I, (We) was/were
� years o age on the � . Thaf I, (We) reside at
�` �
���� `. �� �� � Township,
(STREET OR RURAL RO;TEI (CITY OR TOWN)
1 n
J�A�XJ./.+6» 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:
gal Description or Key Number: ,•�a�^"' �'-
•,
Assessed value of real estate or mobile home as of March
;,.
DEC � 1
1, current year: y�,t__
- �- auo�roR'�
The total annual gross income of this affiant when combined with that of his or
her spouse for the prior calendar year, without any deductions, did not exceed
511,000 and was derived from the following sources and in the following
amounts:
SOURCE OF INCOME
0
AMOUNT OF INCOME
...........................5 ,
(��-.� .............................s la� a.eo
............................ S
TOTAL..S ���a�°�
Were either you or your spouse required to file an income tax return for the preceeding year? Yes `—
No Ii yes, a copy of such return must be submitted for county auditor's inspection.
^ther than a Mortgage or ntract Deduction, do you receive any other deduction from property tax?
s NO you filed application for deduction in this County or any other county?
es NO
I swear under penalty of perjury that the above and foregoing information is true and correct.
'See False Siatement Penalty Below. (On Receipt)
Full Name)