HomeMy WebLinkAboutAge_Wright��„ ,R.n44 AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
` REQUESTING DEDUCTION FROM ASSESSED VALUATION
�> ,��� .� State Fortn 43708 (R6lFOa) �
Prescribed by Ihe Department of local Govemment Finance
�rmaUon contained in this document is CONFIDENTIAL pursuant to IC 6-7.7-72-9 and IC 6-1.1-35-9.
INSTRUCTIONS:
7o be �led in person or by mail witb the County Auditor o( the county wbere
the property is located.
See �everse side (o� additional instruction and qualifications.
COUNTY TOWNSHIP � YEAR
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Fite Mark
JUN 1 1 2007
FILING DATES:
1) Rea! properfy.� nths before May
11 o/the�{�rd� �pn�' ,(pJ��ffective.
2J Mobile Fomes assessed u e`f't � 1-1-7;
between January 15 and March 31 of the yea�
the deduction is to be e/%ctive.
Name of contrect seller (applicant must have 6een buying on confracf at least one (1) year)
Address of conVad seller Is the property in question:
❑ Real property ❑ Mobile home (I.C. 6-7•1-7)
Ta�cing s ct Key number / Legal description Rewrd number . Page number
�. � �2�-/a-�d -/�-ood: ziy_oa
C�-�%�-�
Is the property used and occupied primarily (or Assessed value ot the property as of March 1, cunent year (may nof
his/her residence? exceed $744,000)
❑ Yes ❑ No
Was the applicant 65 years ot age or more on December 31 of the year poes the combined annual adjusted gross income of lhe applicant and any
prior to the currenf year? individuals sharing ownership exceed 525.0007
Yes ❑ No O Yes O No
$
Have you filed (or any other deduciions? If Yes, what deductions?
❑ Yes ❑ No
Have you filed for dedudions in any other county� Ii Yes, what county?
❑ Yes O No
I1We 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 aforemenlioned property on March 1, 20 _ .
Signa � f applicant Signature of authorized representative (by execufed Power ofAttomeyJ
,7
i
ress ot appliwnt Address of authorized representative
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