HomeMy WebLinkAboutAge_Thompson=ai rt''bt AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, courirv TOWNSHIV YEAR
RE�UESTING DEDUCTION FROM ASSESSED VALUATION
.e �
. .
State Form 43708 (R / 9-96)
�"�,�"��' Prescnbed by the State Boartl oi Tax Commissioners
Information contained in this document is CONFIDENTIAL pursuant to IC 6-7.1-12-9. FilB Mark
`� i ° � '+ : � :_�,.
INSTRUCTIONS FOR FILING: � " E� !�� '.
To be liled in person or by mail with the County Auditor o/ the county where the property is loca- �- �° j` '�_ �
ted during the 72 months belore May 77 0) the year the deduction is to be eflective.
Deductions !or mobile homes not assessed as real properry must lile between January 75 and �Y ��' Z���
March 31.
See reverse side lor additional instruction and qualifications. � , / � n
or
or
name on
❑ Yes ❑ No
con aci seller (applicant must have been
�
of ntract seller
Is the property used and �F,c�ied pnmarily for
hisRierre5idence?
was tne appucant 65 years ot age or more on
prior ro the wrrent year?
If filetl by a 5urvrvii
the time of death?
Have you filed for
Have you filed for
�-
any
any
share
on contract at leasf one (7) YearJ
with someone other than spouse,
wiih whom
ay number / Legal description Record number
OO�OO! �����
' ❑ No
ofthe year
age at
❑ Yes L�iv6
❑ Yes C�3i�}�
Assessed value of the property as of March 7
exceed $27.000)
i annuai aa�usted gross mcor
ownership ezceed 520,000?
Souree
urrent year (may not
❑ Yes ❑ No
ne of the applicam and any
❑ Yes ❑ No
Amount ot Income
� 809�'
$
TOTAL I $
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the applicani was a resi-
dent of Indiana and owner of the aforementioned property on March 1, 19�
ature of applicant Signature of authorized represeniative (by executed Power o7Anomey)
tJress of applicant
�R� -� 1
�yu ���P��
Address of