HomeMy WebLinkAboutAge_Hurtn• ! AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
° REQUESTING DEDUCTION FROM ASSESSED VALUATION
S State Form 43708 (RS / 6-03)
w• -
Presaibed by ihe Department of Laal Govemment Finance
Information contained in ihis document is CONFIDENTIAL pursuant to IC 61.1-12-9.
�RUCTIONS:
To 6e filed in person or by mail with the County Auditor of the counry where
the property is located.
See reverse side for additional instruction and qualifications.
FILING DATES:
1) Real piopertf: OQring fYe�2�onths before May
11 0/ the year fhe deduction �s to 6e eNective.
2) Mobile�homes assessed,under I.C.6-1-1J;
between Janua,ryjl5;and Marcli 31 o/the year
the�deduction. is to�be;eftective.�R
Name of applicant (owne� or contract buyer)
�� �7
� ° _/
Is aoo cant the s gal or equitable owner? If No, what i isRier exact s are or inlerest. f owned with someone other ihan spouse,
" indicate with whom
es ❑No
If name on record is different than that of appliwnt, indipte below
Name of wnt2ct seller (applicant musf have 6een buying on conhact at least one (1) year)
Address of conVact seller /� Is the property in question:
� � ��Q�— – (/� � (J �c� �O�/ L1�Real property ❑ Mobile home (I.C. 6-1-7-�
Ta�cing district - Key number I Legal descriplion Record number Page number
.- = =5 .= 03 S%�5"= 'rn�
,
�e property used and occupied pn rily for �
Have you filed for any other deductions? If Yes, what deducfions?
❑ Yes l] No
Have you filed for deductions in any other coun[y? If Yes, what counry?
.❑ Yes �'fJo
IM/e certify under penalty of perjury that the above and foregoing information is true and correct and that lhe applicant was a resident
of Indiana and owner of lhe aforementioned property on March 1, 20 _
Signature of applicant Signature of authorized representative (by executed Power olAttomeyJ
X
Q,-
Addres of applican Address of authorized representative
�� � �y�
�f N�' S �
�_3_�� .���,