HomeMy WebLinkAboutAge_White°` "�"o AFFIDAVIT OF PERSON� 65 YEARS OF AGE OR MORE� COU�17v TOWNSHIP VEAR
�� � REQUESTING DEDUCTION FROM ASSESSED VALUATION
State Form 43708 (R / 9-96)
�`;�, Prescribed by the State Board oi Tax Commissioners
File Mark
Information comained in this document is CONFIDENTIAL pursuant �o IC 6-7.1-12-9.
INSTRUCTIONS FOR FILING:
To be liled in person or by mail with !he Counry Auditor of the counry where the property is loca- j? "� �„�,
ted during the 72 months betore May 71 0) the year the deduction is ro be ef)ecfive. �. [ .S yr�
Deductions for mobile homes not assessed as real property must Iile between January 75 and �' ���°''-�i�+� •n
March 31. ��) 2000
See reverse side !oi additional insVUCtion and qualilications. O�
appiicant tne soie �egai or equrtabi wner %
Yes ❑ No
name on record is diflerent ihan ihai of applican
ame ot contrad s Iler (applicant mus( have beer
� �L.�
� ��
ised and occupied
/ �
narily for
exact
on con[iacr ar �east one (7) year)
�.?;CN '�'
If ownetl with someone o�her Ihan spouse,
indicate with whom
/ Legal de5criptionOO VY/ Rewrd number IPage number
0 (/
D o�'�"a�
Assessed value of the property as of Mamh 1, current year (may not
❑ Yes ❑ No
the applicant 65 years of age or more on December 37 of the year
to the current yeaR
�licant's date ot binh (monfh, day, yeai)
spouse's age at
time of death?
you
you filed for
any
❑ Yes i�No
in any other counry?
❑ Yes
Yes.
❑ Yes ❑ No
combined annual adjusted gross income of the applicam and any
s sharing ownership exceed 520,000?
Souree of Income
counry?
� $
$
TOTAL $
❑ Yes ❑ No
Amounlotlneome
IIWe certify under penalty of perjury that the above and foregoing information is true and correct and ihat the applicant was a resi-
dent of Indiana and owner of the aforemeniioned property on March 1, 19
�ature of applirani I Signature of authorized representative (by executed Power o7AttomeyJ
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