HomeMy WebLinkAboutAge_Manning♦ R�\
`i AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
'� � ` REQUESTING DEDUCTION FROM ASSESSED VALUATION
�' ,��� ✓ State Fortn 43708 (R6 / 4-04)
Prescri6ed by the Depariment o1 Lacal Gavemment Finance
�maGOn wntained in ihis documenl is CONFIDENTIAL pursuant to IC 6-1.1-72-9 and IC 6-1.135-9.
INSTRUCTIONS:
To be �led in person or by mail with the County Auditor of the county where
the property is located.
See reverse side for additional instnrction and �quafifications.
COUNTY TOWNSHIP YEAR
File
FILING DATES: ��� 9n�r,
1) Real property: Duri}tg fhe�l�rrforitlr5 before May
11 0/ the year fhe deduction is to be effective.
2) Mobile homes as�se�se u��,�.61-1-7;
behveen January 15 a� Marcl�l of the year
the deducf/�oi&��@�dG�UDI70R
Name of applicant,(own r or contract buyer) �
� ,
I L � :
Is applirant the sole legal or equitabie ovmef.� If No, what is hislher exact share or interest? ed wiih meone other than spouse,
i icate with om
Yes ❑ No
If name on record is diRerent than that of appliwnt, indicate below
Name of contract seller (applicant must have been 6uying on contract at least one (i) year)
Address of wnGact seller Is the propert , in question:
eal property ❑ Mobile home (I.C. 6-1-1-n
Ta�cing district Key number / Legal description Rewrd number Page number
�0'=�s'—Fr{=0�5=�5= °�e
Is the property used and occupied primarity for Pssessed value of the property as of March 1, curtent year (may not
hisAier residence? exceed 3144,000)
❑ No
Was the applicani 65 years of age or more on December 31 ot the year
$
Have you filed for any olher deductionsl If Yes, what deductions?
❑ Yes ❑ No
Have you filed for deduUions in any other countyl It Yes, what counry?
❑Yes ❑No
I/We certify under penalty of perjury that the above and foregoing information is true and correcl and that the applicant was a residenl
of Indiana and owner of the aforementioned property on March 1, 20 _
Signat�yg of applicant Signature of authorized representative @y executed Powei ofAttomey)
� �_
. �
�ss of appliwni '- f� , � Address of authorized representative
i
� .