HomeMy WebLinkAboutAge_Wildt,°� �_ ^., 1 AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
` REQUESTING DEDUCTION FROM ASSESSED VALUATION
�> � State Form 43708 (R6 / G-0a) �
Presmbed by ihe Depatlment of Lowl Gwemment Finance
�rmation wntained in this document Is CONFIDENTIAL pursuant lo IC 6•1.1•12-9 and IC 6-7.7-359.
�NSrRUCriorvs:
To be filed in person or by mail with the County Auditor o! the county where
the piopeRy is located.
See reverse side fo� additional instruction and qualiTcations.
COUNTY TOWNSHIP � YEAR
�'I
File Mark
MAY 1 6 2007
FlLING DATES:
1) Real prope�y.� g�1,h� i�2 months before May
11 ofj�� earth�educ�i�tis to be e(fective.
2) Mo6�7L1���s��lAl�S�dl�DpiQp�C.6-1-1-7:
between January 15 and March 31 of the year
the deduction is to be e//ective.
Name o applicanf (owner or contract buyer) ' (
�
Is applicant e sole legal or equitable owner? ' If No, what is his/her exacl share or interest? If owned with someone other than spouse,
' - indicate with whom
❑ Yes ❑ No
If name on rewrd is diBerent than that of applicant, indicate below -
Name of contrad seAer (applicant must have 6een buying on conhact atleast one (Q year)
Address of conUact seller Is the property in ques6on:
eal property ❑ Mobile home (I.C. 6-1-7-7)
Taxing district Key number / Legal description Rewrd number Page number
�� �, -oL-� -�Or-�..7 -o�
Is the property us and occupied primarily for Assessed value o( the property as of March 1, curtent year (may not
hislherresiden . exceedS744,000)
OYes ❑No �
Was the applicant 65 years of age or more on December 31 of Ue year poes the combined annual adjusted gross income of the applicant and any
prior to Ne curzent year9 individuals sharing ovmership exceed 525,0007
Yes ❑ No ❑ Yes ❑ No
Ap�p} iwnPS date of birth (monfh, day, yearJ
�
Have you filed (or any other deductions? If Yes, whai deductlo�s? ,
❑ Yes ❑ No
Have you filed for deductions In any other county? If Yes, whal counl�/T
❑ Yes No
I/We certify under penalty of perjury that the above and foregoing information is irue and correct and that the applicant was a resident
of Indiana and owner of the aforementioned propeRy on March 1, 20 _
Signature ot appliwnt Signature ot authorized representative (by executed Powe� ofAttomey)
Y � �
ress of plicant Address of aulhorized representative
x � a -
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