HomeMy WebLinkAboutAge_MemmerAFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, couNrv TOWNSHIP v�aa
REQUESTING DEDUCTION FROM ASSESSED VALUATION G�
S�w > State Form 43708 (R7 / 5-06)
�� Presmbed by Ue Departmem ot Lod Gavemmem Finance
Informalion wniained in this document is CONFIDENTIAL pursuant to IC 6-1.1-72-9 and IC 6-�.1-35-9. ��
INSTRUCTIONS: FILING DATES: �
To be �led in person or by mail wit6 the County Auditor o/ the county where 7) Real pro�{ly�D�d��� months before June
the property is located. 11 0/ the ye�rth n is to 6e eHective.
2) Mo6ile h es assessed under I.C.6-1-1-7;
See reverse side for additional instruction and qualifications. 6etween� 1B arch 31 of the yeai
th�{jB�c�A�toTY AUDITOR
�J
applirant the
name an record is dAlerenl
Narne oi contrad
contract seller
�'ed .
what is
❑ No
been buying on contract at
Property used and oocupied primarily fa
r 25idence7
plicant 65 years of age w more o�
arrent year9
If Aed by a survhnng, i
Ihe time of death?
Have you filed for any
Have you filed for ded
exacl share w
If owned with someone other than spouse,
indipte wiN wFwm
Is the property in question: - �
❑ Real properly ❑ Mobile home (I.C. 6-1-1-�
Rem,d number Page number
a�-�--a7�aoa-oc�. Sla o /
. Assessed value of the property as of March 1, c
� ezceed 8144,000)
❑No
m c31 of the year poes the combined annual adjusted gross incoi
individuals sharing uwnership exceed $25,000?
�s ❑No
Y, day, year)
�—
spouse's age at
any
❑Yes
$
yea. �may,wr
applicant and any
❑Yes ❑No
❑Yes �NO I
IlWe certify under penalty ot perjury that the above and foregoing infom+�r��n is true and correct and thal the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
g359
Y��.LY��t.Q.t�
�.
of auUiwized
Address o( authorized
ofAttomey)