HomeMy WebLinkAboutAge_Sutton°�• 1 AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, iP YE^R
�r ° REQUESTING DEDUCTION FROM ASSESSED VALUATION
�` y� SWte Fortn 43708 (R6 / e-Oa) �
Prescribed by ihe Department of Lowl Govemment Fnance
`�orma6on contained in this document is CONFIDENTIAL pursuant to IC 6•1.1-12•9 and IC 6-7.1359. APR 1 � ZO�I� Mark
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INSTRUCTIONS:
To 6e filed rn person or by mail with the CountyAuditor of the county where
the p�operty is located.
See �everse side /or addifional instruction and qualifications.
FILING DATE'Sria-� �
1 Real ro e �
) p p rty:(Wurin 12 months before May
116f@fi���k�b�d0�h�ro be eflective.
2) Mobile homes assessed under I.C.6-1-1-7;
behveen January 15 and March 31 of tha year
the deduction is to be effective. � -
Name of appl' (owner or conVact b J �
GC+ .
Is applicant the sole legal or equ' owne If No, what is his/her exact share or interest? 1� owned with someone other than spouse,
' indicate with whom
Yes 0 No
II name on record is diflerent an thal of appliwnt, indicate below
Name of contract seller (applicant must have been buying on conUact at least one (1) year)
Address oi contract seller Is the property in question:
Real Oroperty ❑ Mobile home (I.C. 6-7-f-7)
Taxi district Key number / Legal description Record number Page number
. �� �r-o - �9m-cri� .3a� �
Is the property used and occupie primarity (or Assessed value of the property as of March 1, cunent year (may nof
hislher residence? exceed 5744,000)
CIYes ❑No
Was the applicant 65 years of age or more on December 31 0( Ihe year poes Ihe combined annual adjusted gross income ot the applicant and any
prior to the current year7 individuals sharing ownership exceed 525,0007
Yes ❑ No ❑ Yes O No
Appliwnt' Source of Income Amount of Income
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If filed by a surviving, unmarried spouse, whal was tha spouse's age al $
the time of deaih?
� TOTAL $ D UO
i
Have you filed for any other deduC�ons? I( Yes, wha deductions7
❑ Yes ❑ No
Have you filed for deduclions in any other countyT tl Yes, what county?
❑ Yes ❑ No
I/We 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 atorementioned propeRy on March 1, 20 _
Signature of applicant Signature of authorized representative (by executed Powe� olAttorney)
ess of appiicant Address of authorized representafive
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