HomeMy WebLinkAboutAge_Morrisond�'�o.� AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
�s REQUESTING DEDUCTION FROM ASSESSED
, , � VALUATION State Form 43708 (1-90) Prescribed by the
^• � State Board of Tax Commissioners
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Instructions for filing:
To be filed in person or by mail with the County Auditor of the County where the
property is located during the 12 months before May 11 of the year the deduction
is to be effective. Deductions for mobile homes not assessed as real property
must file between January 15 and March 31. See reverse foradditional instructions
and qualifications.
Applicant (Owner or contGact buyer)
County � Township
MAY 0 8 1991 �
Year
Is applicant the sole legal �.J If no, what is his/her exact share or If owned with someone other than
equitable owner? ❑�rJ no interest? spouse, indicate with whom.
If name on record is different than that of applicant, indicate below:
contract
Address of contract seller
District
Is the real property'us
for his/her residence?
must have been buying on contract at least one (t) year.)
Key Number/Legal
�� _ — _ . .S(o_�U� � Page No.
and upied primarily Assessed value of the property as of March 1, current
] s O no year (may not exceed $19,000). �
0
Was�applicant 65 years of age or more on
Dece er 31 of the year prior to the current year?
� es O no
Does the combined annual adjusted gross
income of the applicant and any individuals
sharing ownership exceed $15,000?
O yes ❑ no
Have you filed for any
Have you filed for any deductions in any other county?
ApplicanYs date of birth �
If filed by a surviving, unmarried spouse, what was the
spouse's age at the time of death?
Source of income Amount of incomE
Total
If yes, what deductions?
If yes, what county?
0
UWe certify under penalty of perjury that the above and foregoing information is true and correct and that the appli-
cant was a resident of Indiana and owner of the aforementioned property on March 1, 19
Si4nature Authorized Representative (by executed Power of Attorney)
�
ass of A�
, lC-� ����
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of Representative
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