HomeMy WebLinkAboutAge_Williams (7)Form 323 Fe+seE 1981
ResliEm M me S:a� -
BoatE ol ia� tommissioners
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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
COUNTV AUDITOR WHERE OWNER'S PROPERTY IS LOCATED:
REAL PROPERTY BETWEEN - BETWEEN MARCH 1 AND MAY 10, INCLUSIVE
MOBILE HOME • BETWEEN JANUARY 1 AND MARCH 31, INCLUSIVE
(NOT ASSESSED AS REAL PROPERTI�
(61.1-12-9 AND b1.142-10.1)
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STATE OF INDIANA, ,�1 Q.3:�CJ�'� COUNTY, SS:
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certify that I, (We) was/were
�years of age on the� . That I, (We) reside at
, � I ei �A . IC i.c°Q . , �✓l A�M,r ,,�,�Township,
(SUeet or Rural Route) (Ciry or Town) �
��1.��1 County, Indiana; that I, (We) have owned the following described
� real estate for 1(one) ye r or more prior to laiming this deduction, a r1that I, (We) now reside in
❑ mobile home ����� � � ��� �,��
the premises for which this io is c aime 1�_�� _���
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: ,�d�14'Y���`-� • a� .
�assessed value of real estate or mobile home as of March 1, current ye�
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The total annual adjusted gross income of this affiant when combined with that of
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:
SOURCEOFINCOME
AMOUNT OF INCOME
oa..A. • .................. $
i.�e�,o.� . . . . . . . . . . . . . . . . . . . . . $ 5 k a �j .
�M�( 3ti, a
� l, � r . . . . . . . . . . . . . . . . . . . . . $ iCx-�? 3 .
TOTAL . . . $ 1 QJ� �I •
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Were ei er you or your spouse required to fi �nM�oi�e3tax return for the preceeding year?
Yes�, No . If yes, a copy o�such return st be submitted for county auditor's
inspection. ' � " �
� � O AUDITOR
Other than a Mortga Deduction, do you receive any ot r deduction from property tax?
�Yes No�_.
Have you filed application for deduction in this county or any other county? Yes , No�..
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I swear under the penalty of perjury that the above and foregoing information is true and correct.
'See False Statement Penalty B low. (On Receipt) �
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Filed By�� ' Address_ Phone No.