HomeMy WebLinkAboutAge_McCandless° ,
ej R'"'a AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, courrrv TOWNSHIP VEAR
s, `. RE�UESTING DEDUCTION FROM ASSESSED VALUATION
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�� : State Form 43708 (R / 9-96)
`,�;� '� �' Prescribed by the State Board of Ta. Commissioners
� � � ile Mark
Inbrmation contained in this document is CONFIDENTIAL pursuant to IC 6-7.7-129. .
INSTRUCTIONS FOR FILING: A�JG �,7 �99�
To be filed in person or by mail with the County Auditor o1 lhe county where the property is loca- n
ted during the 72 months before May 77 0/ the year the deduction is ro be eJfective. ( L �
Deductions for mobile homes not assessed as real property must lile between January yand �`�. �' q�
Ma�ch 31. /i..�� �„� TY rUDM'CO�
See ieve�se side lor additional instruction and qualifications.
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Name of p-cant (owner or conbacl buyerJ
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Is applican e sole legal or equitable ner? If No, what is hiyher exact share of interest? If owned with someone other than spouse,
indicate wiih whom
Yes ❑ No
If name on record is diflerent than tha� of applicant, indicate below
Name of contract seller (applicant must have been buying on contract af /easr one (7) year)
IAddress of contraci seller _
p 0 - - G-I• —Gd�
��ing dishict Key number / Leg-1 description -.� Record number Page number
1_ - �
Is the prope ed and occupied primarity for Assessed value of the pmperty as of March 7, curreni year (maynot
his/her residence? ezceed $27,000)
es ❑ No ❑ Yes ❑ No
Was the applirant 65 years of age or more on December 3t of the year
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Have you filed for any other deductions? If Yes, what deductions?
❑Yes ❑No
Have you filed for deductions in any other county? If Yes, what counry?
❑ Yes � No
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant was a resi-
dent of Indiana and owner of ihe aforementioned property on March 1, 19 �
IS=g ture o plicam Signature of authorized representative (by executed Power o1 Attomey)
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. ress o licant - � Address ol authorized represemative
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