HomeMy WebLinkAboutAge_GreenF AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
REQUESTING DEDUCTION FROM ASSESSED VALUATION
�' � State fortn 43708 (RS / 6-03)
M
PfewibeG by iha Departrnent of Loral Govemment Finance
Information contained in this document is CONFIDENTIAL pursuant to IC &1.7-12-9.
INSTRUCTIONS:
To be filed in person or 6y mail with the County Auditor of the county where
the property is located.
See reverse side for additional instruction and qual�cations.
FILING DATES: OrT, G � ZQO3
1) Real property: Y)unng the 12 months before May
11 0( theyea� the deductio'n is to be effective.
2) Mobile homes assgssed under 1��,6�� 1-7;
�-, i � ,.-.. � .., -.2.
6etw erJanuary�l5�and;March;3,1?oLthe year
the deduchon is to 6e eHective.
Name ot applica owner or cont2ct buye
Is applicant the sol egal or eq tab wneY? If No, what is his/her exact share or interest? If owned with someone other than spouse,
indicate with whom
es ❑ No
If name on record is difterent than that of applicant, indiwte below
/ �� �J
Name of coniract s r(applicant t have 6aen buying on con t least one (1J yearJ
Address of conVact seller Is the property in queslion:
�al property ❑ Mobile home (I.C. 6-7-1-�
��cing district - Key number / Legal descriplion Rewrd number Page number
�� - -= -�o=a_1=U� �
Is the property used and occupied primarity for Assessed value of the property as of March 7, current year (may not
hisAier residence? ezceed 5144,000)
�s ❑ No
Was the applicant 65 years of age or more on December 31 of the year
$ �
Have you filed tor any other deductions? If Yes, what deducUons?
❑ Yes C'7'�Jo
Have you filed for deductions in any other county? If Yes, what county? °
❑ Yes G�No '
I/VJe certify under penalty of perjury that the above and foregoing information is true and cortect and that lhe appficant was a resident
of Indiana and owner of lhe aforementioned property on March 1, 20 _
�ature of applicani Signature of authwized representative (6y executed Power olAttomeyJ
..Jdre f plica Address of auNorized representative
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