Age_WheatleyAFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, couNTV TOWNSHIP veaa
REQUESTING DEDUCTION FROM ASSESSED VALUATION �
�• �w / State Fmn 43708 (R7 / SOB) �
Presmbed by tt�e Deparhnent at Loml Govemment Finance
File Mark
InfortnaGon contained in this dowment is CONFIDENTIAL oursuant to IC 6-1.7-72-9 and IC Cr'1.1-35-9. �AR U� 2p08
INSTRUCTIONS: FILING D ES:
To be filed in person or by mail with the County Auditor of the county where 1) Real p�J�(�',JJt� 12 months before June
the property is located. 11 of the� year�ie{� S to be efleciive.
2) h(�(�g�tlr��3essed under I.C.6-1-1-7;
See reverse side for additional instruction and qualifications. 6etween January 15 and March 31 of the year
the deduction is to be eRective.
ame of appGpM (ovmer or c traG buye� -
appGcant the sole legal or equitable owne(?
❑Yes ❑No
name on recortl is ditferent Nan that of applinn
G�
�
must have been buying on contrad at
Is ihe property used and o�Lpied prirharity for
hislher residence? %
one
/ Legal desaiption
❑Yes ONo
the applieant 65 years of age w nrae on Decembec3l oi the year
to the artent year? .
❑Yes ❑No
nnPs date ot birth /
the spouse's age at
No
you filed for deductions in any other counp?
I with someone other Nan spouse,
with whom
Is ihe property in question: �
�pmperty ❑ Mobile home (I.C. 6f4-�
�►?emrd number Pa7e number
�alue of the property as of March 1, current year (may rwt
W.000)
/�od
�mbined annual adjusted gross incorne of the appliqrtt and any
sharing uwnership exceed E25,000?
�Yes ❑No
� s ❑No
IIVJe certify under penalty of perjury that e above and foregoing info�**��r��n is We and correct and thal the applicant was a residenl
of Indiana and owner of the aforementioned property on March 1, 20 _ .
3natura of ap�cant Signature of authorized representative (by executed Power ofAttomey)
of applicant
x iou 3i
n�