HomeMy WebLinkAboutAge_HullFwm 3Z1 Revise0 t980
Prescri�ai Ey tne Stah
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AFFIDAVIT OF PERSON, 65 Y RS OF AGE OR MORE
REQUESTING PROPERTY TAX DEDUCTION ` �
TO BE FILED IN VENSON ON BY M<IL EACH YEIR WITH TXE �`� �\ �Q
COUNTY AUOITOP WHENE OWNEP'S PNOPEPTY IS LOCI.TEU: /'� O 1
NEAL PHOPENTY - BETWEEN MARCN 1 ANO MAY 10. INCWSNE �V;w `
MO61LE HOME - BEiWEEN JANUARY 1/Np MAHCN Il, INCLUSIVE � �a-
(NOT ASSESSED AS REGL VpOVEHTY) i�
U
(Ft142-9 AND F1.14240.1)
STATE OF INDIANA, r��"' COUNTY, SS:
o�-.-n.�- �4e�ia,..� -' ,�c,� c..J,�c�c;2.
I, (We) �• " , certify that I, (We) was/were
7� years of age on the ' . That 1, (We) reside at
'/ �/ �
T�S� �- �Gd�' ��'�x- Township,
(STREET OR FURAUI ROUT.E� �QTY OR TOWN)
(��- County, Indiana; that I, (We) have owned the foilowing described
� real 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: �P�� ��� `�'���ztf[ ��
�gal Description or Key Number: � l".��•NL- �8 �.�
Hssessed value of real estate or mobile home as of March 1, current year �
The total annual g�s� m�f tni:
her spouse for th ri �
511,000 and was derived from the
amounts: � p g ]9�0
SOURCE OF INCOME
�ffiant when combined with that of his or
, without any deductions, did not exceed
following sources and in the following
AMOUNT OF INCOME
. � ' . . . . . . . . . . . . . . s �l /.z.� ,Z8
�-r�-- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . s z 6 0. .�8'
. �� 6 : 79
. : . . . . . . . . . . . . . . . . . . . . . . . . . . . s 9�� �G.
,vna�c+�..
TOTAL..S l3 ��S zI
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 or Contract Deduction, do you receive any other deduction from property tax?
��s NO _�— Have you filed application for deduction in this County or any other county?
s NO _%S—
I swear under penalty of perjury that the above and foregoing information is true and correct.
'See False Statemen�enalry Below. (On Receipt)
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