HomeMy WebLinkAboutAge_OwensaE•°'°v� 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
mustfile betweenJanuary 15 and March 31. See reverseforadditional instructions
and qualifications.
Applicant (Owrfer or
Is applicant the sole leg'al � If no, what is his/hei�xact share or
equitable owner? es ❑ n interest?
If name on record is different than that of applicant, indicate below:
Name of contract seller (Applicant must
Address of contract seller
Numbe
Is the real property used and upied prima�ily
for his/her residence? yes rJ no
Was the a icant 65 years of age or more on
Dece er 31 of the year prior to the current year?
yes O no
Does the combined a al adjusted gross
income of the ap ' ant and any individuals
sharing owne ip exceed $�;bQU'T
O yes no a0,o� �
Have you filed for any other deductions
Have you filed for any deductions in any other county?
on contract at
MAY 0 7 1997
GIBSON
If owned with someone other than
spouse, indicate with whom.
one (1) year
Page No.
at deductions?
If yes, what county?
:�
I/We certify under penaliy 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
Sgnature Authorized Representative (by executed Power of Attorney)
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of Ap licant (/
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Address
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