HomeMy WebLinkAboutAge_Taylor�°—""a AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE�
-� 4 REQUESTING DEDUCTION FROM ASSESSED VALUATION
�S� .� Stare Porm 43708 (R / 9-96)
'�`,e,� ���' Prescribetl by the State Boartl oi Tax Commissioners
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.7-12-9.
INSTRUCTIONS FOR FILING:
To be liled in person or by mail with the County Auditor o! the county where the property is loca-
ted during the 12 months betore May � 1 0l the year the deduction is to be effective.
Deductions !or mobile homes not assessed as real property must file beRveen January 75 and
March 31.
See reverse side !or additional instruction and qualitications.
ame ot appiicant (owner or cont�acl buyeq
applirant ihe sole legal or e' able owner'!
�
❑Yes ❑No
name on rewrd is differeni than tha� of applican
ame of coniraa seller (applicant must have bee�
idress of coniract seller
hxing disirici ,
�.J��'�,�.,crn
the property used and occupied primarily for
�Iher residence?
on contract at least one
number I Legal description
❑ Yes ❑ No
the applicant 65 years of age or more on December 37 of the year
to ihe current year?
ied spouse, what was
any
ne spouse's age a
❑Yes ONo
❑ Yes ❑ No
COUNTV TOWNSHIP YEAR
i��' � S
�. f
� i . f
�- _ _ t,-fiife'FAark
�� 1 � 2���
/'��/` -�"✓�Y`f'%.,��
%u_r y J ..:.. . .
�J _ _
I With SOmBOnB
wi[h whom
number
spouse,
number
� -o� I I
;ed value of ihe property as of March 1, cuvent year �may nof
❑ Yes ❑ No
combined annual adjusted gross income of the applicant and any
s sharing ownership exceed 520,000?
I/We certify under penalty of perjury that ihe above and foregoing information is true and correct and that the applicant was a resi-
dent of Indiana and owner of the aforemeniioned property on March 1, 19
ature of applicant Signature of authorized represeniative (by executed Power olAttomeyJ
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