HomeMy WebLinkAboutAge_Elpers (3)� AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, counTV TOWNSHIP r�
REQUESTING DEDUCTION FROM ASSESSED VALUATION�
S�w State Fortn 43708 (R7 / SOB)
PresaLed b�' ihe DeP�en� ot Lacal Gwemmeni Fvarce
File Mark
��rmation contained in this document is CONFIDENTIAL pursuant to IC fr1.7-12-9 and IC 6-1.1-35-9. O C T 1 1 Z00%
INSTRUCTIONS: FILING DATES:
To 6e filed in person or by mail with the County Auditor of the county where 1) Real �' the 12 months 6efore June
the property is located. 1 i o/ the ye .the d ction is to be eflective.
2��F%�9��1`sAk�80Ader I.C.6-1-1-7;
See reverse side /or addftional instruction and qualifications. 6etween January 15 and March 31 of the year
the deduction is to be eRective.
ame ot applicartt (owner or conbact dryer) -
appGcant the sole legal or equita ovmef?
❑Yes ❑No
name on record is different than that of applinn�
Address of contraG
(applicant must have been
s the applicant 65 years ot age or more on uea
�r to �he current yeaR
dicanYs date of
tirne of death?
Have you filed for any
you filed for deductions in any
No, }vhat is hisTher exad share w
�g on contraci at least one (7) yearJ
� number I Legal description
_ / _ �' Assessed value o1
ezceed 8144, 000)
No
e year
❑No
ise's age at
❑Yes �No
If owned vrith saneone other ihan spouse,
indirate with whom
property in question: �
❑ Real property ❑ Mobile home (I.C. 6-7-1-�
RorrvA numher Paae number
as of March 7, current year (may rwi
�mbined annuai adjusted grvss income of ihe applicant and any
sharing ownership exceed 525,000?
❑Yes ❑No
Source of Inwme Amount af income
$ �-I'j�.G�
� $
TOTAL S �
tdeductions? �
❑Yes ❑No I
I/We certify under penaliy of perjury that the above and foregoing info�+*+�t��n is We and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
�nature of appGcant Signalure of authorized representative (by ezecuted PowerWAttomeyJ
representative