HomeMy WebLinkAboutAge_Hilldj �'' � AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
d REQUESTING DEDUCTION FROM ASSESSED VALUATION
�+ , State Form 43708 (R / 9-96)
`' Prescribed by the Siate Boartl of Tax Commissioners
Information contained in Ihis document is CONFIDENTIAL pursuant to IC 6�1.1-72-9.
INSTRUCTIONS FOR FILING:
To be liled in person or by mail with the County Auditor of the county where the property is loca-
ted during the 72 months before May 77 of the year the deduction is to be eltective.
Deductions for mobile homes not assessed as real property must lile beRveen January 75 and
�Anrrh '] 1
COUNTY TOWNSHIP YEAR
File Mark
�°7 �� '� i .� v .�
J. . . ...
APR j �• 2000
See reverse side !or additional instruction and qualilications.
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Name of a licam (owner - r contract buyeiJ �•: �,_ JLN rij�riTy ���'"'� •
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Is applirant the sole legal or equitable owner? It No, what is hisfier exact s e of inierest? If owned with someone other than spouse,
p� indirate with whom
Yes ❑ No 0 0
If name on record is diflerern than hat of applicant, indirate below
Name of contraci seller (applican( must have been buying on contract alleast one (1) year)
Address of contreci seller
�zing strict Key number / Legal description Record number Page number
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Is ihe property used and occupie primarily for Assessed value of ihe property as of March 1, current year (maynot
hismer residence? I exceed $21,OOOJ �7
Yes ❑ No � Y / C) ❑ Yes ❑ No
Was the applicant 65 years of age or more on Decem6er 37 of ihe year poes ihe combined annual adjusted gross income of the applicant and any
prior to ihe curreni year? individuals sharing ownership exceed 520.000?
C-� � ❑ Yes ❑ No
ApplicanYs date of binh (month, day, year) �
Have you filed for any other deduciions? If Yes. whai deductio s
o o /
�i Yes ❑ No `-`� ���
Have you filed for deductions in any other county? If Yes, what couniy?
❑ Yes No
I/We certify under penalty of perjury that the above and (oregoing information is true and correct and that ihe applicant was a resi-
dent of Indiana and owner of the aforementioned property on March 1, 19
Signature ot applicant Signature of authorized representative (by executed Powei o/ Attorney)
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N •
�dress of applicant Address of auihorized representative
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