HomeMy WebLinkAboutAge_PeavlerFmn� 3?3 fle✓sea 1921
Presai�ecl4/ Ne 53x
Boara ol iaa Gomn6sioners
AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE
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 i AND MAY 10, INCLUSIVE /�� /
MOBILE HOME - BETWEEN JANUARY 1 AND MARCH 31, INCLUSIVE
(NOT ASSESSED AS REAL PROPERTY)
�TATE OF INDIANA,
1•12•9 AND 61, 1•12•10.1)
SS:
I, (We) , certify that I, (We) was/were
�ye s of age on the�'� That I, (We) reside at
/(o U%�Qc�.,� � 7%7 a.�-.J , Tlc.-�.« a���� Township,
(Street or Rural Route) (CUy or Town)
�� 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
�J 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 above:
Legal Description or Key Number: °[7 � n ���,�.
Assessed value of real estate or mobile home as of March 1, curre?ft year:
Were eit. hgr you or your spouse required to file an income tax return for the preceeding year?
Yes V , 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��.
Have you filed application for deduction in this county or any other county? Yes , No �.
�swear under the penalty of perjury that the above and foregoing information is true and correct.
See False Statement Penalty Below. ( n Receipt)
� /� O � (S4.c�C� .d= T'v�7 l' .✓
File Address n� Phone No.
�/
_ —� il � ,s _. .. ...../,.�. �