HomeMy WebLinkAboutAge_MurphyForm 323 Rersed 1981
PreSUibeE Gy Ne Sa;e
BwrG ol ta� Car.ucissimers
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STATE OF IND
AFFIDAVIT OF PERSON, 65 YEARS (�F AGE OR MORE
REQUESTING PROPERTY TAX DEDUCTION
TO BE FILED IN PERSON OR BY MAIL EACH YEAR WITH THE � l gg �
COUNTY AUDITOR WHERE OWNER'S PROPERTY IS LOCATED:
REAL PROPERTY BETWEEN • BETWEEN MARCH 1 AND MAY 10, INCLUSIVE
MOBILE HOME - BETWEEN JANUAHV 1 AND MARCH 31, INCLUSIVE
(NOT ASSESSED AS REAL PROPERTI�
1-12-9 AND 6-1.7-12-10.1)
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UNTY, SS:
certify that I, (We) was/were
�years of age on the � That I, (We) reside at
7�.3 ,0. < /�.r�� Township,
(SUe or ural Route) (Crty or Town)
f����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 surviving unremarried spouse:
Spouse's age at the time of death:
Name of property tax records if different from
Legal Description or Key Number:
�ssessed value of real estate or mobile home as of March 1, current ye�:��
The total annual adjusted gross income of this affiant when combined with thaYd
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:
SOURCE OF I
AMOUNT OF INCOME
�u�c. . �-� • . . . . . . . . . . . . . . . . . . . $
' ��it-o� i"l�-�� . . . . . . . . . . . . . . . . . . $ /f 5�G • G �J
$ �—
..................... a
�-x,�. . 6 0 . o 0
TOTAL . . . $
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Were either you or ur spouse required to i e an income tax return for the preceeding year?
Yes , No�_. If yes, a copy of�:r;�113 ret��� must be submitted for county auditor's
inspection.
��'ti�r than a Mo�rtga Deduction, do y,o�ec�tv J ction from property tax?
�.:� you filed applica ion for deduction in this county or any other county? Yes , No x,,_.
�__:. �ar under the penalty of perjury that the above and foregoing information is true and correct ��
See F e Statement Penalt Below. (On Receipt)
7/ -3,�: ����� �-� _
FiledBy: ' ' -• Address � PhoneNO.
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