HomeMy WebLinkAboutAge_GibbsForm 3D Ilevise0 19fip
RescriUd Uy Ue S�ate
Baara ot ia. commksioners
�
AFFIDAVIT OF PERS�IV,�S Y�R� OF AGE OR MORE
REQUESTING PROPERTY TAX DEDUCTION
TO BE FILEU IN PENSON OR BY MAIL E/.CH YEAP WIiH TNE
COUNTY AUDITOfl WMEflE OWNER'S PROPENTY IS lOC/.TED:
HEAL PNOVEPTY - BETWEEN MAPCM 1 AND MAY 10. INCLUSIVE
MOBILE HOME - BEiWEEN JANUAPY 1 I1ND M/HCH �l, INCWSIVE
' �NOT /SSESSED AS PE/.L GPOGEPTY)
(61.14P-9 ANp 61.14240.p
STATE OF INDIANA, �lJ.L7UC,1��'Y\ COUNTY, SS:
I, (We) l.,J�.�i�L�i� e� v W , certify that I
�years of age on the � T�af
--� � � �l C'�� �—
�STREET OR RURAL ROUTE)
l�
(We) was/were
I, (We) reside at
Township,
County, Indiana; that I, (We) have owned the foliowin9 described
real estate
for 1(one) year or more prior to claiming this deduction, and That I, (We)
❑ mobile home
now reside in ihe premises for which this deduction is claimed:
Surviving Spouse: Ii application_is being made by a surviving unremarried spouse:_
Spouse's age at time of death:
Name on property [ax records if different from above: .�
�� �K�,�,c�4 33 �a,�-�-- -3�
A�Description or Key Number:
sed value of real estate or mobile home as of March 1, current year: 1��� '��17�
__ ,
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.
;�er than a Mortgag�or Contract Deduction, do you receive any other deduction from property tax?
NO Have you filed application for deduction in this County or any other county?
res NO
I swear under penalty of perjury that the above and foregoing information is true and correct.
'See False Statement Penalty Below. (On Receipt)
� �� ♦ n � \
rmi rvame�