HomeMy WebLinkAboutAge_Douglas�....,,a
� AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, couNTV TOWNSHIP rFaR
ir '° REQUESTING DEDUCTION FROM ASSESSED VALUATIO�
�'\_�! State Fortn 43708 (R6 / 4-04) �
Presuaed by lhe Department of Lowl Govemment Finance
File Mark
in•�rmation contained in lhis documenl is CONFIDENTIAL pursuant to IC 6-1.7-72-9 and IC 6-1.1-35-9. FEB 1 g Z��S
INSTRUCTIONS: FILING DATES:
To be filed in person or by mail with the County Auditor ot the county where 1 Re�'�f ert : the 12 months be(ore Ma
the propeRy is located. )11 ofKhA�r lhe ucfion is to 6e eHective. Y
7��� j�,g.t795Sd9�4�Ai}�der/.C.6-1-1-7;
See reverse side !or additional instniction and qualifications. between January 15 and March 31 0/ the year
• fhe deduction is to 6e effective.
applicant (owner or contract buyer)
r\ . A n
or
No, what is
Q Yes ❑ No �
If name on record is ditferent than that of applicant, indicate below
contract
oF wnGact seller
occupied primarity for
residence?
on contrect at �east one
Key number / Legal description
'as ihe applicant 65 years of age or more on December 3� e year
ior to the current year?
es ❑ No
�pliwnPs date of birth (month, day, year)
�•
;�what was the spouse's age at
e time of deaih?
ave you filed (or any other deductions?
❑ Yes ❑ No
ave you filed for deductions in any other wuniyl
❑ Yes ❑ No
or
I vnN someone
with whom
Is the propeAy in question:
spouse,
❑ Real property ❑ Mobiie home (I.C. 67-7-�
Record number Page number
ihe property as of March 1, wvent year (may not
�
IlWe certify under penalty ot perjury that the above and foregoing information is true and correct and that the applicani was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
of authorized represeniative (by executed