HomeMy WebLinkAboutAge_BruceA n�ry
,°r„__ '�, AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
" REQUESTING DEDUCTION FROM ASSESSED VALUATION
�' ,��� � SWte Fortn 43708 (R6! 404)
Prescnbed by the Depanmem ol Lowl Govemment Finance
�rmation wniained in this document is CONFIDENTIAL pursuanl to IC 6-1.7-12-9 and IC 6-1.135-9.
INSTRUCTIONS:
To be filed in person or by mail with the CountyAuditor of the county where
the property is located.
See reverse side fo� additional insVuction and qualifications.
COUNTY TOWNSHIP YEAR
� �
JUNFVF �a2�E107
FILING DATES:
1) Real prope�ty: Dunng fffe�2��s before May
i� orcne ye�f$g���e�,oAy�rad��ra�crr�e.
2) Mobile homes assessed under I.C.6-i-1-7;
between January 15 and March 31 0l the year
the deductron is to be elfective.
Name of appliwnt (owner or contrecf buyer) �
. (
!
Is applicant e sole legal or equitable owner? If No, what is,his/her ex r r interest? If owned with someone other than spouse,
' indicata with whom
❑ Yes ❑ No
I( name on record is difierent than that of applicant, indicate below
Nama o( wntrad seller (applicant musf have been buying on con7sct at least one (7) year)
Address of conVact seller Is the property in questlon:
❑ Real property ❑ Mobiie home (I.C. 6-f•f-7)
Taxing district Key number / Legal descriplion Record number Page number
�� �lo -/ .3 -/,J �.� 00 - 000, /a 7. 6
Is the property used and occupied primarily for Assessed value o( the property as o( March 1, curtent year (may not
hisfier residence? axceed 5744,000)
❑ Yes ❑ No
Was the applicant 65 years of age or more on December 31 of the year poes the combined annual adjusted gross income of the applicant and any (
prior to the current yearl individuals sharing ownership exceed 525,0007
O Yes ❑ No ❑ Yes ❑ No
ApD����Ps date of birth (�th, day, year) �
$ �
Have you filed for any other deductions? I( Yes, what deducUons7
�.S Yes ❑ No
Have you filed for deduUions in any other county? If Yes, what wunty7
❑Yes ❑No
I/We certify under penalty of perjury that the above and foregoing information is lrue and correct and that the applicant was a resident 'I
of Indiana and owner of lhe aforementioned property on March 1, 20 _ �
Signature of applicant Signature of authorized representative (by executed Power o7AttomeyJ
� �a � ��
�'re s o1 applicant Address of authorized represenlative
/? o, Box 220 OAKC�N� C�T� /�•
�7�p