HomeMy WebLinkAboutAge_Whittingtonej �a AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
�-` = RE�UESTING DEDUCTION FROM ASSESSED VALUATION
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State Form a3708 (R / 9-96)
�° Prescnbed by the State Board ol Tax Commissioners
Information comained in this documeni is CONFIDENTIAL pursuant to IC 6-1.7-12-9.
INSTRUCTIONS FOR FILING:
COUNTV I TOWNSHIP
Mp� ? 1 iuUO
To be filed in person or by mail with the Counry Auditor of the county where the property is loca- ♦�
ted during the 72 months before May 7 7 0/ the year the deduction is to be e8ective. �' �
Deductions !or mobile homes not assessed as real property must lile between January 15 and. '--
March 3 L � ' . _ _ � . s .�iTO?
See �eve�se side lor additional instruction and quali(ications.
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YEAR �
Name of applicani (owner or cont�act buye�)
Is applicanl the sole legal or equitable owner? If No, what is hislher exact share of int st? If owned with someone other ihan spouse,
indicate with whom
es ❑ No
If name on rewrd is diNerent than ihat of applicant, indicate below
Name of contraci seller (applicant musf have been buying on contracf af least one (i) year)
Address of contract seller
ing disirict Key number / Legal description Record number Page number
o -0090 -�
Is the property use nd occupied pnmarily for Assessed value of the property as of March 1, current year (may not
his/her residence? exceed $2t,000)
❑ Yes ❑ No ,3 3 ao ❑ Yes � No
Was ihe applicant 65 years of age or more on December 37 of the year poes the wmbined annual adjusted gmss income of the appliwm and any
prior to ihe curreni year? individuals sharing ownership exceed 520,000?
❑ Yes ❑ No
Applicant's dat t binh (mon�h, day, yearJ Source oi Ineome Amount of Income
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TOTAL $
Have you filed for any other deductions? If Yes, what deductions?
�4es ❑ No a"
Have you filed for deductions in any other county? If Yes, what counry?
❑ Yes �Jo
I/We certify under penalty ot perjury that the above and foregoing information is true and correct and that the applicant was a resi- -
dent of Indiana and owner of the aforementioned property on March 1, 19 �
ISignature of applicant Signature of authorized represemative (by execured Power o7Aftomey)
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...,dress of applicant Address of authorized representative