HomeMy WebLinkAboutAge_Jones (2)�a rtnrG
= AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
iQ REQUESTING DEDUCTION FROM ASSESSED VALUATION
S � SWte Fortn 43708 (R6 / 4-Od)
Prescribe0 by Ne Department ot Local Govemment Finance
�rtnation contained in ihis docu{nent is CONFIDENTIAL pursuant to IC 6-7.1-12-9 and IC 6-1.1-359.
INSTRUCTIONS:
To 6e �led rn person or by mail with the CountyAuditor of the county where
the p�operty is located.
See reverse side for addi6onal instiuction and qualifications.
COUNTY TOWNSHIP YEAR
�� �
File Mark
MAY 5 2005
FILING DATES:
1) Real property: Du '�� ���s 6efore May
11 0( the year the ded ion is e ective.
2) Mobile hor����i��i�c�W .� -1-7;
6etween January 15 and March 31 0l the year
the deduction is fo be effective.
Name of applicani (owner or contract buyer)
• A �
�
Is applicant the e legal or eq ble owneR If No, what is hisltier exact share or interest? If owned with someone other than spouse,
' indicate with whom
s ❑ No
I( name on record is diRerent fha at of applicant, indicate below '
Name of contract seller (applicant must have been buying on rnntract at leasf one (7) year)
Address ot wntract seller Is the property in question: •
�Real property ❑ Mobile home (I.C. 6-7-7-n
Ta�dng district Key number / Legal descriptlon Rewrd number Page number
" ba �� _aa
Is the prop used and o pied primarily f Assessed value o( the property as ot March 1, current year (may not
hismer resi nce? exceed $144,000)
�es ❑ No
Was the appliwnt 65 years of age or more on December 31 of the year poes the combined annual adjusted gross income of the applicant and any
prior to the cunent year? � individuals sharing ovmership exceed $25,0007
�es ❑ No ❑ Yes
P.pplicanPS date of birth ( Source of Income Amount of ncome
$
I( filed by a surviving, unmarried spouse, what was e spouse's age at $
the time o( death?
TOTAL $
Have you filed for any other deductions? If Yes, what deducGons7
�es ❑ No
Have you fled for deductions in any other county? If Yes, what county?
❑ Yes
I/We certi(y 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 _
Signature of applicant Signature of authorized representative (by executed Powei olAttomey)
�
, ss of applicant . - Address of authorized represenlative