No preview available
Age_Slunder" AFFIDAVIT OF PERSON� 65 YEARS OF AGE OR MORE� COUNTY ��TOWNSHIP YEAR :- ; REQUESTING DEDUCTION FROM ASSESSED VALUATION 1I��� J ti, •-1 � {t�� , � , State Fwm 43708 (R3 / 8-00) li � � :� �/ Ji •'• Prescribed by Ne Stale BoarE ot Ta�c Commissioners � �� rmation contained in ihis document is CONFIDENTIAL pursuant to IC 61.7-12-9. J U L 1� C6fla� Mark INSTRUCTIONS FOR FILING: �-,( / To 6e filed in person or by mail with the County Auditor o/ the county whe2 the property is lo ����``�"'��''��'`��`�`J� ted dunng the 12 months 6e(ore May 11 of the year the deduction is fo be e8ective. C:tgSOP� Cu�:� �+' %+���� � OR I Deducfions lor mobile homes not assessed as 2a1 property must file befween January 15 and March 31. See reverse side (or addiGonal instiucGon and qualifica6ons. Name of appiicant (owne ntract buyer) . s- -- - Is applipnt lhe sole lega or equitab o nefi I No, what is his/her exad sha r interest7 if owned with someone other than spouse, indicate with whom 5 o r,a If name on rewrd is different than that of appiicant, indicate below Name of contrad seller (ep licanf musf have been buying on contract at least one (1) yea� � , : Address of contrad se I r � ing dis iG Key number / Legal description Recorcl number Pa9e number a o--o_�-�aa�� �_d Is the real property used and occupi d Assessed value of the property as of March t, curtent year (may not primarity for hisTher residence? ezceed 569,000) � C9'�es ❑ No Was the applicant 65 years of age or more on December 31 of the year poes the combined annual adjusted gross income of the applicant and any prior to the current yea(J individuals sharing ownership exceed 325,0007 �s ❑ No ❑ Yes ❑ No Applipnfs date of $ Have you filed for any other dedudions7 � If Yes, what deduc6ons? u Yes ❑ No Have you filed for deductions in any other counry? / If Yes, what county? ❑ Yes ❑ No I/We certify under penalty of perjury that fhe above and foregoing information is lrue and correcl and that the applicani was a resi- dent of Indiana and owner of the aforementioned property on March 1, 20 _ Sgnature of appliwnt Signature ot authorized representative (by executed Powero/Attomey) ress of applip Address of authorized representative �°,R.'13