HomeMy WebLinkAboutAge_Schmidty;%""" z AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
-` REQUESTING DEDUCTION FROM ASSESSED VALUATION
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�� _'� State Form a3708 (R / 9-96)
;a,�- •" ' Prescribed by ihe State 8oard ol 7az Commissioners
Intormation contained in this document is CONFIDENTIAL pursuant to IC 6-1J-12-9.
INSTRUCTIONS FOR FILING:
To be liled in person or by mail with the County Auditor ol the county where the property is loca-
ted during the 72 months belore May 71 0/ the year the deduction is to be el%ctive.
COUNTY TOWNSHIP YEAR
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Deductions !or mobile homes not assessed as �eal property must lile between January 15 and
March 31. I///`` �
See reverse side !or additional instruction and qualilications. ,�''�14.17 �
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Name of appli t(ownei or conhact buyer) •
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Is applirani e oie le r equitable owner? If No, whai is his/h xact share of interesi7 If owned with someone other than spouse.
� indiCate with whOm
❑Yes ❑No
If name on rewrd is dittereni Ihan that of applicant, indicate be�ow
Name of contracl seller (applicant must have been buying on conhact at least one (1 J yeai)
Address of coniract seller
�district Key number / Legal description Record number Page number
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Is the propeny used and occupied primarily for � Assessed value ot ihe property as of March 1, current year (may not
hislher residence? exceed $27,000)
es ❑ No ❑ Yes o
Was the applicant 65 years of age or more on December 37 of the year poes the combined annual adjusted gross income of ihe applicant and any
prior to ihe current year? individuals sharing ownership exceed 520.000?
❑ Yes ❑ No
Applicant'
$
Have you filed for any other deductions? If Yes, what deductions?
❑Yes ❑No
Have you filed for 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 appticant was a resi-
dent of Indiana and owner of the aforementioned property on March 1, 19
ISgnature of applicant Signature of amhorized representative (by executed Power olAnomey)
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. r f applicant Address of authorized represeniative
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