HomeMy WebLinkAboutAge_Davis (8)n��
� AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
REQUESTING.DEDUCTION FROM ASSESSED VALUATION
t+ Sfata Form 43708 (RS / 603)
� •
P'esuiEetl Dy Me Department of lxai Govemrtrent Finance
� ation contained in this document is CONFIDENTIAL pursuant to IC E1.1-12-9.
COUNTY TOWNSHIP YEAR
File Mark
RUCTIONS: FILING DATES:
To 6e filed in person or by mail with the County Auditor of fhe county where 1) Real property: Dunng the 12 months before May
tbe property is located. 11 0l the year the deduction is [o be ef/ective.
2) Mobile homes assessed under I:C:6-1-1-7;
See reverse side for additional inslruction and qualificafions. between January 15 and Maroh 31 0/ the year
tbe deduction is to be eflective.—r �i �•
� ���lf 'V
�. is hisRier exaa share or interest?
Ly�Yes ❑ No I
name on record is diRerent than that of applirant, indicate below
.C77ilt'rShc
on
number
f / IIT
i �
and occupied primarily for
es ❑ No
Was the applicant 65 years of age or more on December 31 of the year
prior to the current year? ,��,/
td'�'es ❑ No
filed by a surviving, i
�e tlme ot deaN?
ave you filed for any
ave you filed for ded
�, /
spouse, what was the spouse's age at
uctlons? If Yes,
LKYes ❑ No c�
anyoNercounty? t Yes,
IIIN 1 Q 20�4
If owned vrith someone other Nan�spouse, n
indiwte vdN whom f ��/
/(�i �.�-�-:�-
/, G�ngQ;! C<%G" � ,._-
Is the property in question:
❑ Real property ❑ Mobile home (I.C. 6-1-1-n
property as of March 7, curtent year
not
combined annual adjusted gross income of the applicant and any
s sharing ownership exceed 525,000?
Souroe
�t�l PS �C�
whatcounry?
❑ Yes ❑ No
Amount of Income
�
s
TOTAL 5 �,
❑ Yes f�No I
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 1, 20
authorized
� � !� a 7� �'�,,,,.�.�.. � y �s ���