HomeMy WebLinkAboutAge_Tyring. =� '
• dj rt,�4 AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, couwrv TOWNSHIP VEAR
`. REQUESTING DEDUCTION FROM ASSESSED VALUATION
}��E�• Stare Form 43708 (R / 9-96) �
';�O �' Prescribed by ihe State Board of Taz Commissioners i�'G:
1 M rk J
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9. " _ �:�
INS7RUCTIONS FOR FILING:
To be liled in person or by mail with the CountyAuditor ol the county where the property is loca- SEP 2 2 �998 -
ted during the 12 months before May 77 of the year the deduction is to be eflective. /�
Deductions for mobile homes not assessed as real property must file between January 75 and �/ C% ii (�
March 31. lry' s.�-���
�
See reverse side for additional instruction and qualilications. GI3SOt+ �_�: 7'r AUDITC. � �
of applipant4d1FL2i o� contract
E�.: _ _ � � l�l��CL
applicant the sole legal or equitable own ? If what is his/her exaci
Yes ❑ No
name on record is diNerent than that ot applicant, indicate below
�al ��
convact
contract
Is ihe property use
hisfier residence?
Was ihe applicani 65 years of age or more on
prior to ihe current year?
filed by a
�e time of
you filed for any other
on
of interest?
wned auui someone otner inan spouse,
icate with whom
e —
C�'D`3 •= O l-l�s%oa
Assessed value of the property as of March 1, cunent year (may nof
exceed S27,000)
Yes ❑ No �Z� �a ❑ Yes ❑ No
er 31 of ihe year poes ihe combined annual justed gross income of the applicant and any
individuals sharing ownership ezceed 520.000?
� ��. � ,%-
spouse, wh was ihe spouse's age at
iciians?
❑Yes �No
you filed for deductions in any
whai
❑ Yes ❑ No
Source of Income Amount of Income
$
$
TOTAL $
❑ Yes �jNo I
I/We certify under penalty of perjury that the above and foregoing information is true and correct and ihat ihe applicant was a resi-
dent of Indiana and owner of ihe aforementioned property on March 1, 19
ature ot applicant SignaW re of authorized representative (by executed Powei o7AttomeyJ
applicant
�� .I i . /• _ _
_\
of authorized
..