HomeMy WebLinkAboutAge_Falls,;o n.n `� AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
'� REQUESTING DEDUCTION FROM ASSESSED VALUATION
�' � State Fartn 43708 (R6 / 4-04) �
�•• Prescribed by Uie Departmem of Local Govemment Finance
rmation wntained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.1-35-9.
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor of the county where
the propeRy is located.
See reverse side fo� additional instruction and qualifications.
COUNTY TOWNSHIP YEAR
�
File Mark
�AR 2 9 2006
FlLWG DA ES:
1) Real properry: Dudngt6e 12 months before May
,I/..c N� T.
11 o(the��%a�iAe deducho��.( to be effective.
2JMobil �o�esQSS�s�fln�rl.C.6-1-1-7;
b�n January 15 and March 31 of the year
the deduction is to 6e eNective.
Name of applicant (owner or contract buyer) �
� �
Is applicant the so e lega or equitable owneR If No, what is his/her exact share or interest? If owned with someone other than spouse,
' indicate with whom
❑ Yes ❑ No
If name on record is diRerent than ihat of applicant, indicate below
Name of contrect seller (applicant must have been buying on con[ract at least one (1J yearJ
Address of contraU seller Is lhe property in question:
eal property ❑ Mobile home (/.C. 67-1-n
Tawng district Key number / Legal description Rewrd number Page number
, 3-�3-�
Is ihe property used and occupied primarily tor Assessed value o( the property as of March 1, currenl year (may not
hismer residence? exceed 3144,000)
es ❑ No
Was the appliwnt 65 years of age or more on Dec ber 31 of the year poes the combined annual adjusted gross income of ihe appiicant and any
prior to the cunent year? individuals sharing ownership exceed $25,0001
es ❑ No ❑ Yes No
P.ppliwnYS date of birth (month, day, year)
Have you filed for any other deductions? If Yes, what deductions?
❑ Yes ❑ No
Have you filed for deduUions in any other countyl I( Yes, what county?
❑Yes ❑No
1/We certify under penalty of perjury that the above and foregoing information is true and correct and that lhe applicant was a resident
of Indiana and owner of the a(orementioned property on March 1, 20 _
S�qnature o pplicant Signature of authorized represeniative (by executed Power ofAttomey)
�1
�ss ot applicanC . - Address of authorized represenWtive