HomeMy WebLinkAboutAge_Maikranza;_rt'n`i AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
'� �'� REQUESTING DEDUCTION FROM ASSESSED VALUATION
� .° State Fortn 43708 (R6 / 4-04)
Prescnbed by the Depanment of Lowl Govemment Finance
COUNTY I TOWNSHIP
C
YEAR
Ir1(6rma6on contained in ihis document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.1-35-9. ��� � Fde�Pl�tk�
8 gJ
INSTRUCTIONS: FILING DATES: �� �'�
To 6e filed in person o� by mail with the County Auditor of the county where 1) Real property: ��g tbe 42.�p{�jhs 6e(ore May
the propeRy is located. 11 of the year the deduction4s�H�be eHective
See reverse side tor additional instruction and qualifications.
Is applipnt the sole legal or
If name on record is difleren
Name of conVact seller (apF
_ Yes ❑ No I
han that of applicant, indiwte below
;ant musf have been buvino on cont
Key n
�
hisAier residence?
es
Was the applicant 65 years of age or more on December 31 c
prior to Ne cuvenl year? _
I( filed by a surviving,
the fime of death?
you
you
or
2) Mobile homes assessed unde� I.C.6-1-1-7;
between Janu 31 0l the year
the ded���ga�toC0UN7Y qUDITOR
0
I with someone
wifh whom
Is the property in question:
❑ Real property ❑ Mobile home (I.C. Crl-1-�
er / Legal descriptlon Record number Page number -
1 � � �� � O O
Asseued vatue o( the property as of March 1, curtent year (may not
exceed 5144,000)
❑ No
he year poes the combined annual adjusted gross income of the applicanf and any
individuals sharing ownership exceed $25,0001
�s ❑ No
nmarried spouse, what was the spouse's age a
�ther deductions?
Yes ❑ No
ictions in any other counry?
❑ Yes ❑ No
Source of Income Amount of Income
g,g ' $ �y�5�6 . o
$
TOTAL $
❑ Yes �'fdo �
I/We certity under penalty of perjury that the above and foregoing information is Vue and correct and that lhe applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20
t_
ess oT ap icant ,J G� Address of authorized representative
� �� /�� �� ��� �