HomeMy WebLinkAboutAge_Smithd'�"" t_ AFFIDAVIT OF PERSON, 65 YEARS OP AGE OR MORE,
'. — ,, ;,"REQUESTING DEDUCTION FROM ASSESSED VALUATION
•� f State Form 43708 (R3 / 8-00)
PrewibeC by ihe State Board of Ta�c Commissioners
�mation contained in this document is CONFIDENTIAL pursuani to IC 6-7.1-12-9.
INSTRUCTIONS FOR FILING:
To 6e �led in person or by mail with the County Auditor of the county where the property is loca-
ted during the 12 months be%re May 11 0/ the year the deduction is to 6e effective.
Deductions /or mobile homes not assessed as real property must (le belween January 15 and
March 31.
See �everse side for additional instruc6on and qualifications.
appliwnt the sole legal or equitable owner? � If No, what is
,�7Yes ❑ No �
name on record is dit�erent than that of appliwnt, indipte t
ame of contrad seller (applicant must hava been buying on
idress of contrad seller
a g sUict Key nurt
'1 (�. �k. , � 1 wJIIJ - C(._.1\=
�s ❑ No
'as the appliwnt 65 years o( age or more on December 37 of the year
ior ro Ne wrrent yearJ
❑ Yes ❑ No
�plicant's dale of
at
e time of death?
you filed for any other deductions?
you
any
❑ Yes ,PJ No
❑ Yes
or
one (1l yearJ
COUNTY TOWNSHIP YEAR
� File ark O �
��� � �
FEB 16 2001
If owned with someone other than spouse,
indicate wiih whom
Record number Pa9e
�
property as of March 7, wrrent year �
�mbinetl annual atljusteA gross income of the appliwnt and any
sharing ownership exceed 525,000?
I/We ceAify under penalty of perjury that the above and foregoing information is true and correct and that the applicant was a resi-
dent of Indiana and owner of the aforementioned property on March 1, 20 _
Signature of applicant Signature of authorized representative (by executed Power ofAttomey)
— V (Ol.i/
.ess of applicant .r�y 67b Address of authorized representative
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