HomeMy WebLinkAboutAge_Johnson�•°'�" o,.� e°�AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
,•'��"��. REQUESTING DEDUCTION FROM ASSESSED County Township Year
'; � VALUATION State Form 43708 (1-90) Prescribed by the
°• State Board of Tax Commissioners
•
Instructions for filing: " i e ark
To be filed in person or by mail with the County Auditor of the County where the � I 7 1998
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 propert� ��
mustfile betweenJanuary 15and March 31. See reverseforadditional instructior�„,�t.
and qualifications. �. „ �;�v %!,IDITOR
Applicant (Own�r or contract buyer)
�
Is applicant the sole legal or If�n , what is his/her exact share or If owned with someone other than
equitable owner? ❑ yes O no i� erest? 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 of contract seller
T�ng_District�, Key Number/L al Description Record No.
- - � — - Page No.
Is the real property used and occupied primarily Assessed vaiue of the property as of March 1, current
for his/her residence? O yes O no year (may not exceed $19,000).
Was�pplicant 65 years of age or more on ApplicanYs date of birth _/� \'
� yes ❑ no If filed by a surviving, unmarried spouse, what was the
spouse's age at the time of death?
Does the combined annual adjusted gross Source of income Amount of income
income of the a licant and any individuals � � r7
sharing owner ip exceed $15,000?
❑ yes o `--'
Total
Have you filed for any other deductions? If yes, what deductions?
Have you filed for any deductions in any other county? If yes, what county?
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)
� �.c,�:
Address of Applicant Address of Representative
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