HomeMy WebLinkAboutAge_Resler�;� AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, cour+TV TOWNSHIP YEAR
`6 REQUESTING DEDUCTION FROM ASSESSED VALUATION
'�� �,� � Stata Form d370B (RS / 6-0J)
Fresaibed by ihe Depariment of Local Govemment Finance
Infortnation containeC in Ihis dowmenl is CONFIDENTIAL pursuant to IC 61.7•72-9. � File Mark
�i--d � il T� �7 �
iTRUCTIONS: FILING DATES: � ! �J
o be filed in person or by mail with the County Auditor o/ the county where �� -� L� o'
ri i��./ i
the property is /ocated. 1J Real properry: Dunng (he 12 months before Mey
�-• 11 o/fhe� earth �ded
See reverse side lor additional instruction and qualifications.
Name of applicant (owner q
Is apoliwnt Ne sole legal or
If name on record is difteren
Vame of conVact seller ( p
'�ddress o( conVa t seller �
or
j]Yes ❑No
lh5n Nat ot aooliwn�.
baen buying on confract at leasf one (7) yearJ
❑ Yes
s tha applicant 65 years of age or more on December 3'
�r to Ne curtent year9
Yes
dicant s date of buN (month, day, year)
�-
was the spou
time ol death7
you filed for any
❑ Yes
you fled for deduc[ions in any other
❑ No
he year
❑ No
age at
��Y 1 e p ctron �s fo be ef/echve.
2) Motiile homes as�s�essed under I.C.6•1-1J;
6ehveen January;l5 and March 37 0/ the year
, �fhe deduction irto be eflective.
ir ownad witn someone other than spouse,
indiwte with wl�om
Is the properry in quesGOn:
eal property ❑ Mobile home (I.C. 6-1•1-�
ecord numbar Page number
��y�
S.�_�!
�sed value of the properry as of March t, curreni year (may nof
�d 5144,000)
what counry?
17 Yes � I
I/We certify under penalty of perjury thai ihe above and foregoing infonnation is true and correct and that the applicant was a resident
o( Indiana and owner o( the aforementioned property on March 1, 20 .
representative (6y
�
6