HomeMy WebLinkAboutAge_Toth° rt•' AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
! ..-. s
° REQUESTING DEDUCTION FROM ASSESSED VALUATION
�+ / State Form a370B (R614-Oa) '
Prescnbed by ihe Depariment of Local Govemment Finance
�rmation wntained in this document is CONFIDENTIA� pursuaM to IC 6-1.7-72-9 and IC 6-1.1-35-9.
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor o/ the county where
the propeRy is located.
See �everse side lor additional instruction and qualifications.
COUNTY I TOWNSHIP I YEAR
FILING DATES: �UN
1) Real propeRy: Dunng t�e ���onths 6e(ore May
11 of the year_the deduction is to be ef(ective.
2)Mo6ilehomes`�'ssessedfv derl.C.6-1-1J;
betw�B�anu�, C�1Y�5 an�rch 31 of the year
the deductJ on i�Yd��TcffAt[[v9qy
Name of applicanl (owner or contract buye�) '
/
Is applipnt ihe sole legai or equitable ovmeR I No, what is hisRier exact share or Interest? If owned with someone other than spouse,
' indicate wiih whom
❑ Yes � No
If name on record is diBerenl than ihat o( applicant, indicate beiow
Name of contrad seller (applicant must have been buying on conNact at feast one (i) }rear)
Address of contract seller Is fhe property in question:
❑ Real property ❑ Mobile home (/.C. 6-7-7-7)
Tauing disirict Key number / Legal description Rewrd number Page number
_ — _ /
Is the property used and occupied primarily for
❑ Yes C3Mo
Have you filed for deductions in any other county? I( Yes, what county?
❑ Yes No
IM/e 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 7, 20 _
Signature of applicant Signature of authorized representative (by executed Power oJAttomey)
�ress of applicant � Address of authorized representative
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