HomeMy WebLinkAboutAge_Powers,.° • t AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, courm TOWNSHIP vFaR
� ` REQUESTING DEDUCTION FROM ASSESSED VALUATION �
,
�� ,��� .� State Fortn a3708 (R6 / 4-Oa) '
Prast+ibed by ihe Department ol Local Govemment Finance
File Mark
, ormaUon wntained In Nis document is CONFIDENTIAL pursuant to IC 6-t.t-12•9 and IC 6-1.1-35-9. O � 2p07
�UN
INSTRUCTIONS: FILING DATES:
To be �led in person or 6y maii with the County Auditor of the county where 1) Real prop � Duri �¢ 12 months before May
the property is located. 11 0/ the y� i� �duc�q(�{ fo 6e eNective.
2) M ��e��b�q�,���,'s�Hh�r 1.C.6-1-1 J;
See reverse side lor additional instruction and qualifications. be en January 15 and March 31 of the year
the deduction is to be effective.
o( applicant (owner
or
nameon
l�
p No
conVad seller (applicant must have 6een buying on contract
property use
r residence?
exactsFk� orinterest?
ona
description
� �• S
❑ Yes ❑ No
Was the applicant 65 years of age or more on December 31 of the year
prior to the cunent yearl
tl
I If Yes,
❑ Yes O No
any alher counry?
❑Yes ❑No
If Yes,
If owned with someone
indicate wifh whom
Is the property in question:
spouse,
❑ Real property ❑ Mobile home (I.C. 6-1-7-�
Record number Paqe number
� value of the praperty as of
f44,000)
the wmbined annual adjusted gross inwr
luals sharing ownership exceed 325,0007
IM/e certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
ot
`
4?b�a
Address
o(authorized