HomeMy WebLinkAboutAge_Abbottdj^"o AFFIDAVIT OF PERSON� 65 YEARS OF AGE OR MORE� Cout�rtv TOWNSHIP YEAR
e `� REQUESTING DEDUCTION FROM ASSESSED VALUATION
�• State Form a3708 (R / 9-96)
"�, Prescribed bY tha State Board of Tax CommiSSioners
Inbrmation contained in ihis document is CONFIDENTIAL pursuant to IC 6-1.7-72-9. File Mark
INSTRUCTIONS FOR FILING: ��
To be filed in person or by mail with the Counry Auditor of the county where the property i���
ted during the 72 months be%re May 7 7 of the year the deduction is to be elfective.
Deductions !or mobile homes not assessed as real propeRy must lile behveen January 75 a,�E C 0'7 1999
March 31.
See reverse side lor additional instruction and qualilications. � �,�,_,�
Name of app�[ani (owne� or cont�ac( buyeQ
� /� '
Is applicant i� sole I or equitable owner�
l
❑ Yes ❑ No
If name on record is diHerent ihan thai of applican
exact
Name of conirad seller (applicant must have been buying on contract at least ane (7) year)
of coniract seller
a �-�3-
IS Ih8 pfOp2Ry uSE
hisRierresidence?
for
the applicani 65 years m age or more on
to ihe curtent year?
� �
If fiied by a surviving, unmarried spouse.
the time of death?
Have you filed for any other deductii
Have you filed for deductions in any
� - �06 a�oa
Key number / legal description
i�(es ❑ No
December 37 of the year
�
was the spouse's age at
O Yes ❑ No
ny?
❑ Yes ❑ No
Ii ownetl with someone
indicate with whom
�0�5-��
Record number
spouse,
number
Assessed value of the property as of March 1, current year (maynot
eXCeed 527.000f
❑ Yes �
Does the combined annual adjusted gross income of Ihe appiicant and any
individuals sharing ownership exceed 520,000? �
IlWe certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant was a resi-
dem of Indiana and owner of the aforementioned property on March 1, 19 _
Signature of authorized representative (by executed
Address of
J
�Y�-�4?��0
L,