HomeMy WebLinkAboutAge_Griffindj �'�'v AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
` REQUESTING DEDUCTION FROM ASSESSED VALUATION
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State Form 43708 (R / 9-96)
�';�"��, Presttihetl by the State Boartl of Tax Commissioners
Information contained in this document is CONFIDENTIAL pursuani to IC 6-7.7-72-9.
INSTRUCTlONS FOR FILING:
To be /iled in person or by mail with the Counry Auditor of the counry where the property is loca-
ted during the 72 months be%re May 77 0/ the year the deduction is to be effective.
Deductions for mobile homes not assessed as real p�operty must lile behveen January 15 and
March 31.
See reverse side !or additional instruction and qualilications.
COUNTV TOWNSHIP YEAR
File Mark
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x. . �.. A �:�r+
,qpR 1 � 2000
ame of ap � ani (owner or contracf buyerJ
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applirant ihe sole legal or equitable owner? If No, what is his/her ezact share of interest? If ownec
indicate
� Yes ❑ No
name on record is diNerent ihan that of aDplicant, indicate below
contrad
contract
must have been buvino on contract at least one
with someone other than spouse,
with whom
m trict Key number / Legal tlescriptfon Record number Page number
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Is the property used and occupied prima ily for Assessed value of ihe property as of March 1, wrrent year (may not
his/her residence? exceed $21,000) ,
Yes ❑ No /� Q�� ❑ Yes ❑ No
Was Ihe applicant 65 years of a or more on De mber 37 of `he year poes ihe combined annual adjusted gross income of Ihe applirant and any
prior to the current year? % individuals sharing ownership exceed 520,000?
�� ' l��-l� S C�-- ❑ Yes ❑ No
Applicant's date of birth (mon h, day, year) � �„
$
Q —
I/VJe certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant was a resi- -
dent of Indiana and owner of the aforementioned property on March 1, 19
�.ature of applicant Signature of authorized represeniative (by executed Power olAttomey)
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