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Home My WebLink AboutAge_Hyneman` aj'"'v AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, courm TOWNSHIP VEAR -a ° RE�UESTING DEDUCTION FROM ASSESSED VALUATION A � � State Form 43708 (R / 9-96) . 11 • Q� ��5� /1 �!' ,�,-, Prescribed by the State 9oartl of Tax Commissioners V-�\ �{�,�.7 1 � ilei ark Information comained in ihis document is CONFIDENTIAL pursuam to IC 6-1.1-12-9. p�Q S��I� �� j {e ' p ._.n � INSTRUCTIONS FOR FILING: M�v To be liled in person or by mail with the County Auditor o/ the counry where the property is loca- 1 Inl �� 2�� ted during the t2 months belore May 77 of the year the deduction is to be effective. n Deductions lor mobile homes not assessed as real property mustlile between January 75 � � n (/ March 31. � `—"� �� -�-�-J� �� '� See reverse side for additional instruction and qualilications. ��,` ��,p; �!`^U'<TY %'!:i� � On � Name of applicant (owner r ntract buyer/ Is applicant the sole legal or equita le owner? If o, w at is hisiher exac shar � f in e es ? It owned with someone oiher than spouse, indicate wiih whom es ❑ No If name on record is diflerent than ihai of applicant, indicate below IName of contract seller (applicant must have been buying on contract at leasf one (7) year) Addres5 of contraCt seller � g isirict Key number I Legal description Record number Page number Q��i, � o O b- o o Y a� 0 0, Is the property used and occupied primarily for Assessed value of the property as of March 7, curreni year (may nor hisRier residence? exceed $2t,000) � � Yes ❑ No . ❑ Yes J.d�fGo Was the applicant 65 years of age or more on December 3� of the year poes the combined annual adjusted gross income of the applicant and any prior to the current year? individuals sharing ownership exceed 520.000? �� p Yes o Applicanfs date of birth (month, day, year) Source ot Income Amount of Ineome $ If filed by a surviving, unmarried spouse, what was the spouse's age at SS $�� , ihe time of death? TOTAL S Have you filed for any other deductions? It Yes, what deductions? ❑ Yes No Have you filed tor deductions in any other county? If Yes. what counry? ❑ Yes No I/VJe certify under penalty of perjury that the above and foregoing information is true and correct and that the applicani was a resi- dent of fndiana and owner of the aforementioned property on March 1-tJ— ISignature of applicant Signature of authorized representative (by executed Power otAttorney) �ddress of appli t � Address of authorizetl representative t� � a a�o � d