HomeMy WebLinkAboutAge_Cleveland?���\4: AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
��' REQUESTING�DEDUCTION FROM ASSESSED VALUATION
i • State Fortn 43708 (R6! 4-04)
Prescnbed by the Depanmem of Local Govemment Finance
TOWNSHIP I YEAR
�,�,1,.�E
Informalion contained in this document is CONFIDENTIAL pursuant to IC 6-7.1-12-9 and IC 6-1.735-9. �
INSTRUCTIONS: , FILING DATES:
To be �led in person or 6y mail with the CountyAuditor of the county where 1) Real property: During th��ynqnths be(ore May
the propeRy is located. 11 of the year the deductio`rtis {o �e��tive.
�� 2) Mo6ile homes assessed under I.C.6-1-1-7;
See �everse side (or additional instruction and qualifications. between January 15 h�? the year
the deduction iy�q�gffec ' . �
(owner or con(ract
or
I( No, what is his/her exact share or
V �p Yes ❑ No �
name on record is diHerent than that of applicant, indicate below
contract
-:,_..,
Iressbf contracl seller
and occupied primariry for
the applicant 65 years of age or more on
to the current year?
date of
ed by a surviving, unmarried spouse,
lime of death?
you filed for any other
you filed tor deduclions in any
on contract at least one (i) year)
Key number
❑ Yes ❑ No
mber 31 of the year
YJ Yes ❑ No
spouse's age at
❑Yes ❑No
exceed 3144, OOOJ
If owned with wmeone other than spouse,
indicate with whom
property in question:
eal property ❑ Mobile home (I.C. 67-1-n
as
year
$
a
❑ Yes ❑ No I
I/We certity under penalty of perjury that the above and foregoing information is true and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20
3 ture of applicant _^ „ _ Signature of authorized representative (by executed Power otAttomeyJ