HomeMy WebLinkAboutAge_French�g�°�
Fvm323fle.ised1981 AFFIDAVIT OF PERSO , 65 YEARS OF AGE OR MORE (),
Prmrn�e� by Ne Stale
0mrd al Taa �mm��,��e�, 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 MARCH 1 AND MAY 10, INCLUSIVE
. MOBILE HOME - BETWEEN JANUARY / AND MARCH 31, INCLUSIVE
� (NOT ASSESSED AS REAL PROPERT� -
(6-1.1-12-9 AND &t.l•12-10.1)
STATE OF INDIANA, /L���t- COUNTY, SS:
I, (We) 4�..i�'"?tM�'t- .%i2vx-��- , certify that I, (We) was/were
�years of age on the � �That I, (We) reside at
.3 / o G• � �/'7«.e-t_ , YiL..�.c..�ix-, Township,
(SVeet or Rural Route) (Cay or Town)
�.4.�.c.abs�. County, Indiana; that I, (We) have owned the following described
� 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 survivin �nremarried spouse:
Spouse's age at the time of death: 5
Name of property tax records if different from above: .
Legal Description or Key Number: ��la-�*-r.�Lc .Z ,Q-� .
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
SOURCEOFINCOME
AMOUNT OF INCOME
� _ ,C�. � f%l.t�e� i
$
..... h1AY�9��1986...$ Z000 —
�- ....;.�.!.................
. . ?'�j'�Jn�� (� n. $ .
��
TOTAL ...$ � o 0 0 �
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 Mortgage Deduction, do you receive any other deduction from property tax?
Yes , No�.
��ve 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.
'_ ee Ise Statement Penalty Below. (On Receipt)
—�— /� 3 /o � �j „�._�. �n,�.,,,,�;L„�
� sa sy <k�L
-� ue y: Address Phone No: �