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Home My WebLink AboutAge_Whitehead� ej-""o AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, ` � REQUESTING DEDUCTION FROM ASSESSED VALUATION i' ;: � ' State Form a3708 (R / 9-96) �� Presui6ed by the State Boartl of Tax Commissioners � � •• Information contained in this document is CONFIDENTIAL pursuant to IC 6-7.7-12-9. INSTRUCTIONS FOR FILING: COUNTY TOWNSHIP YEAR � � �� i.t� 1'ii FlF.ile�Aadc�1 �� JUL 0 9 1999 To be liled in person or by mail with the County Auditor ol the county where the property is loca- ted during the 12 months belore May i l o/ the year the deduction is to be effective. / � Deductions lor mobile homes not assessed as real p�opeRy must lile between January 75 and �^--��L �,.-'^�� March3L ��0�+'�:��U?!-iY ;'�DiT�"t , See reverse side !or additional instruction and qualitications. Name of applicant (owner or contracl6uyerJ d cl � c( � -�-� l�%1-�-�e �eQd� Is applicant ihe sole legal or equitable owner? If No, what is his/her exact share of interest? If owned with someone other than spouse, indiCate with whom Yes ❑ No If name on record is ditterent than that of applicant, indicate below Name of wntraa seller (applicant must have been buying on contracf af least one (1) year) � � Address of contract s Iler Taxing district Key number / legal description Record number Page number ��o � l,�m �j �. c0:0"-3=-9�-7-��r=�=aZ�' Is the property used and occupied primarily for Assessed value of the property as of March 1, current year (maynot hisfier residence? exceed 321.000) iYes ❑ No ❑ Yes No Was the applicani 65 years of age or more on December 31 of the year poes the combined annual adjusted gross income of ihe applicani and any prior to the current yeaR individuals sharing ownership exceed 520,000? ❑ Yes ❑ No Applicant's date of birth (month, day, year) Source oi lneome Amount ot Income _ $ If filed by a surviving, unmarried spouse, what was the spouse's age at $ the time of death? TOTAL $ Have you filed for any other deduciions? If Yes, what deductions? ❑Yes �No Have you filed for deduciions in any other couniy? If Yes, what county? � ❑ Yes o IIVJe 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 the aforementioned property on March 1, 79 SignaWre of applicam Signature of authorized representative (by executed Power o/Anomey) l � �� ress ot applicant Address of authorized representative l � 9 � ��`�" `'''/