HomeMy WebLinkAboutAge_Schafera ^•n
„e _, `� AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
'� � REQUESTING DEDUCTION FROM ASSESSED VALUATION
�> .� Slate Fortn 43708 (R6 / a-Oa)
� •�.
Prescnbed by Ne Department of Local Government Finance
Infortnation contained in this document is CONFIDENTIAL pursuani to IC 6-7.7-12-9 and IC 6-1.7-35-9.
INSTRUCTIONS:
To be filed in person or by mail with the CountyAuditor o( the county whe�e
the propeRy is located.
See reverse side !or additional instniction and quali(cations.
COUNTY TOWNSHIP YEAR
� � 4, � ,i;
FEB 2'o�Mao�00s
FILING DATES:
1) Real property: ,�onths 6e(ore May
11 0( the year the d& ,tr'Q(! i o 6e effective.
2)Mobi/eh�5���s�" 9'Lh�1.C.6-1-1-7;
between January 15 and March 31 of the year
the deduction is to be e/lective.
Name of appiicant (o ne� or conVact buyer) �
� T— � -
� — i
Is applicant the sole legal or equitable ownel? I( No, what is his/her exact sh or interest? If owned with someane other than spouse,
' indicate with whom
Q Yes ❑ No
If name on record is diBerent than Nat of applicant, indicate below
Name of contracl seller (applicant must have been buying on contract at least one (7) yeai) .
Address of wnVad seller Is the property in question:
❑ Real property ❑ Mobile home Q.C. 674-n
�ng district Key number / Legal description Record number Page number
G��o -D/ �%a30- 90
Is the property used and occupied primarily for Assessed value of the property as of March 1, current year (may not
hismer residence? exceed 5144,000)
Yes ❑ No
Was the appliwnt 65 years of age or more on December 31 o e year poes the combined annual adjusted gross income of the applicant and any
prior to the current year? individuals sharing ownership exceed $25,0007
❑ es ❑ No ❑ Yes ❑ No
AppliwnCS date of
�:, $�-
If (Jed by a surviving, unmarried spouse, what was the spouse's age at $
the lime of death?
TOTAL 5
Have you filed for any other deductions? If Yes, what deducUons?
❑ Yes ❑ No
Have you filed for deductions in any oNer county? If Yes, what county?
❑ Yes ❑ No
I/We certify under penalty of perjury that the above and foregoing information is true and correcl and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
Signature of appli Signature of authorized representative (by executed Power ofAttomey)
�
._re of applicant . � Address of authorized represenWtive
'�