HomeMy WebLinkAboutAge_PritchettFwm 77! Fev¢m 1�0
Resul�en W ine s,a;e
Boa�U al Ta. Cornissioners
.�
��L
\ `
^--_ )
STATE OF INDI
AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE
REQUESTING PROPERTY TAX DEDUCTION O��\�
TO BE FILED IN PENSON Ofi BY MAIL EACH YEAP WITM THE
COUNTY AUOITOF WMEPE OWNEP'S PPOPENTY IS LOC<TED:
REAL PFOPEFTY - BETWEEN MRFCN 1 AND MAY 10. INCLUSIVE
MOBILE HOME - BETWEEN JANUANY i AND MANCH 31, INCLUSIVE
�NOT ASSESSED AS REAL PROPERTY)
(6-t142-9 AND 61.1-12.10.1)
� COUNTY, SS:
I, (We) �/ � ��� �w �-✓l,l_A.L.v�t.�J1 , ce�tify that I, (We) was/were
�years of age on e �� . ThaE I, (We) reside at
�a i . , ��� � P,�t.�,.� Township,
(STFIEET Ofl RURA� O�y�E� (CITV OR TOWN)
_A1ddFJXI��:Y� 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)
❑ 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:
_' _ epallDescription or Key Number. IV J o5 J
Hsse�"s�ed value of real estate or mobile home as of March t, current year: �JOO—a�OD
The total annual gross income of this affiant when combined with that of his or
her spouse for the prior calendar year, without any deductions, did not exceed
S11,000 and was derived from the following sources and in the following
amounts:
SOURCE OF INCOME
AMOUNT OF INCOME
4��' i C 0 �-X�- .............................5 �—
�n��ok .............................s l 3la ,$3
.` ., .�> _i � a
. � C j.� ' �
! j � �_ �, •
FE62o 1597
Wer eithe ou or your spouse required to file an income tax return for the preceeding year? Yes
Nod�f� py of such retum must be submitted for county auditor's inspection.
AUDITOR O � -
Other tFian a Mortgage 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?
.�
r;' NO �
I swear under penalty of perjury that the above and foregoing information is true and correct.
'See False Statement Penalty Below. (On Receipt)_