HomeMy WebLinkAboutAge_Stone Form 323 Revised 1930 AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE 7
Board of W the mire
Board pi Tax Commissioners REQUESTING PROPERTY TAX DEDUCTION `'
TO BE FILED IN PERSON OR BY MAIL EACH YEAR WITH THE 14\ V
_ COUNTY AUDITOR WHERE OWNER'S PROPERTY IS LOCATED:
r REAL PROPERTY - BETWEEN MARCH 1 AND MAY 10, INCLUSIVE
.�' MOBILE HOME - BETWEEN JANUARY 1 AND MARCH 31. INCLUSIVE
(NOT ASSESSED AS REAL PROPERTY)
(6-1.1-12-9 AND 6-1.1.12-10.1) 001 -60037
STATE OF INDIANA, ,��L 1�' y"�� COUNTY, SS:
I, (We) - U " — , certify that I, (We) was/were
n w 7(� years of age on the n day of I I &Cr. , 19 7—crg. . That I, (We) reside at
RR'( iMic R 6bJt a & ��vi l/14_ Township,
(STREET OR RURAL OUTE),.., )(CITY OR TOWN)
�+ L/ 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: it
Spouse's age at time of death: _17-1-12-4172C ti U
•Name on property tax records if different from nalbove: ,1 r tit-ea ri�O�/y�/� "
,gal Description or Key Number: p+.. RE I q NLi I/Li- - 1 (-3- 9 F6717e._
Assessed value of real estate or mobile home as of March 1, current year: JD70-30on
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
A S 150 . (0Li
LOAtt L, • s _ lk (.pa ' L19
. ... K
12"4 ,g, _D S 8 sco 02. 0 p.
FILED TOTAL. .S I O S 13 ' 13
Wer 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.
MAY 2 5 1989
Alpher than a Mortgage or Contract Deduction, do you receive any other deduction from property tax?
Have you filed application for deduction in this County or any other county?
Yes �
es
AUDIT
I swear under penalty of perjury that the above and foregoing information is true and correct.
'See False Statement Penalty Below. (On Receipt)
y. t Wior Ittrniti RR i 134. 168 6a4.&4 Ct(��
(Owner's Full Name) `r (Owner's Complete Address)
5 r.