HomeMy WebLinkAboutAge_McKinneyn4i AFFIDAVIT OF PERSON� 65 YEARS OF AGE OR MORE�
'� '� REQUESTING DEDUCTION FROM ASSESSED VALUATION
> �.% State Fartn 43708 (R6 / 4-0a)
• Prescribed by Ne Depariment of Local Govemment Finance
�nation wntained in this documenl is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.135-9.
INSTRUCTIONS:
To be filed in person o� 6y mail with the County Auditor of the county where
the property is located.
See �everse side for additional instruction and qualifications.
Is applicant the sole legal or equitable owner!
es ❑ No
If name on record is difierent than Nat of applican
Name of w�tract seller (applicant must have
residence?
i ��
rhat his/her exact share or interesG
below
on contract at least one
�y number / Legal description
� � � 0//�/- � 0
Ihe applirant 65 years of age or more on December
to the curtent year?
�-/
by a surviving, unmarried spouse, what was the spoi
ie of death?
you filed for any other deductions?
❑ Yes
you filed tor deductions in any other county?
❑ Yes
❑ No
he year
❑ No
age
❑ No
COUNTY TOWNSHIP YEAR
� �
�����` 4 2006
FILING DATES:
1) Real property: Dunng the 12`month'sE6efore May
11 otthe yearth�de�ncfiw�is�t4 �e��ecfive.
2) Mobile homes assessed un�'er 1. C.6-�1T`f%R
6etween January 15 and March 31 of the year
the deducfion is to be effective.
I with someone olher than spouse,
with whom
Is the property in question:
eal property ❑ Mobile home (I.C. 6-1-1-n
Ne property as
year
�mbined annuai adjusted gross inwme of the applicant and any
sharing ovmership exceed $25,000?
Income
�
$
TOTAL $
❑ Yes � No
Amount of Income
�
I/We certify 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 _
ature of appiiwnt
� l� /'
ss of applicant � p
SS�1 L � �„r �Y'�.
representative (by executed Power olAttomey)