HomeMy WebLinkAboutAge_Tryon°"""4 AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
d/ t REQUESTING DEDUCTION FROM ASSESSED VALUATION
la:!�s
Stare Form 43708 (R / 9-96)
�")�" l Prescribed by Ihe State Board ol Tax Commissloners
Intormation contained in this document is CONFIDENTIAL pursuant to IC 6-7.7-72-9.
INSTRUCTIONS FOR FILING:
To be liled in person or by mail with the County Auditor o! the county where the propeRy is loca-
ted during the 72 months before May 17 0/ the year the deduction is to be ellective.
Deductions lor mobile homes not assessed as real property must file bertveen January 75 and
March 31_
See reverse side lor additional instruction and qualilications.
Is
(owner Or Gontracl buyerJ
or
��
❑ Yes � No I
name on record is ditterent �han that of applicant, indicate below
of contract se
:s of contract
share
must have been buying on contract at least one (i) yearJ
sfier residence?
as the applicam 65 years of age or more on
ior to the curreni year?
�plicanPS date of birth (month, day, yearJ
filed by a surviving, unmarried spouse, what
e time of death?
ave you filed for any oiher deductions?
ave you filed tor deductions in any other cou
Key number / Le9al description
(o- � I �j3-G
� Assessed value of the
exceed $21,000)
Yes � No
December 31 of the year
❑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 resi-
dent of Indiana and owner of the aforementioned property on March t, 19
iature ot apyjcant Signature of authorized represeniative (by executed Power ofAttomeyJ