HomeMy WebLinkAboutAge_Henning�_� • 1 AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, courm TOWNSHIP rea.rt
'� ''' REQUESTING DEDUCTION FROM ASSESSED VALUATION
�� ,� � ! Stata Fortn a3708 (R6l 4-04) �
Prescribed by the DeDartment of Local Govemment Finance
File y�.�
�rmaUon contained in this document is CONPIDENTIAL pursuant to IC 6-1.7-1&9 and IC 6 (�- 5-9. �
INSTRUCTIONS: FILING DA : � � �J
To be (led in person or by mail with the County Auditor of the county where 1) Real pr eRy: During the 12 months before May
the propeRy is located. . 11 0/ the year f�s�ediic('ZprZiS{i� be eBective.
2) Mobile homes assessed under 1.C.6-1-1-7;
e reverse side for addifional insfruction and qualifications. 6etween January 15 and Ma�ch 31 of the year
� � the deduction is�t��fl"ecfrUe*
or
the sole legal or
If name on record is
contract seller
a A �
❑Yes ❑No
than that of appiicant,
occupied primarity for
� appliwnt 65
-��
y a surriving, unmarried spouse, what was
of dealhY
you filetl tor any oNer deducti�
you filed for deductions in any
� what is hisRier exad share or' te esl?
e below
on conhsct at least one (1) yea�)
Is the
/3 a� oaa.�
:y number / Legal description
❑ Ye5
❑ No
he year
❑ No
age
���
�L�i/•
:d value of
S�ae,000�
e combine�
ais sharing
whatdeductions?
what wunty?
If ownetl with someone other than spouse,
indicate with whom
property in queslion:
❑ Real property ❑ Mobile home (I.C. 6-1-1-7)
Record number Page number
perty as of March 1, curtent year (may no1
I adjusted yross income of the appiirant and any
❑ Yes ❑ No
$
❑ Yes f$,�No � �� \r
.3
IPNe certify under penalty of perjury lhat the above and foregoing information is true and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
1 r �•
•
�
authorized representative (by execu(ed