HomeMy WebLinkAboutAge_Bryns,. °'"o AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
°�f � � � REQUESTING DEDUCTION FROM ASSESSED
_�; � VALUATION State Form 43708 (1-90) Prescribed by the
•�• State Board of Tax Commissioners
��
Instructions for filing:
To be filed in person or by mail with the County Auditor of the County where the
property is located during the 12 months before May 11 of the year the deduction
is to be effective. Deductions for mobile homes not assessed as real property
must file between January 15 and March 31. See reverse for additional instructions
and qualifications.
County � Township
a�� o � �sss
Year
Applica�n"t�'(O1"her or contract bu r) •
YvI�IICLM � i'r1S `�"
Is applicant the sole�gal or If no, what is his/her e ct share or If owned with someone other than
equitable owner? yes O no interest? spouse, indicate with whom.
If name on record is different than that of applicant, indicate below:
Name of contract seller (Applicant must have been buying on contract at least one (1) year.)
Address oP contract seller
District � Key Numbe
Is the real pro�erty used and occupied primarily
for his/her residence? � yes O no
Was the applicant 65 years of age or more on
December 31 of the year prior to the current year?
�yes ❑ no
Does the combined annual adjusted gross
income of the applicant and any individuals
sharing ownership exceed $15,000?
O yes �no
Have you filed for any
?
Have you filed for any deductions in any other county?
� —C:JV � � Page No.
If yes, what deductions?
If yes, what couhty? "
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the appli-
cant was a resident of Indiana and owner of the aforementioned property on March 1, 19
Signature Authorized Representative (by executed Power of Attorney)
of Applicant ' Q � Address of Representative