HomeMy WebLinkAboutAge_Atchisonej'—""a AFFIDAVIT OF PERSON� 65 YEARS OF AGE OR MORE� CoUt�v TOWNSHIP
-` ' REQUESTING DEDUCTION FROM ASSESSED VALUATION
,
$late Form 43708 (Fi/ 9-96)
�`;�" �, Prescri6ed by the Sta;e Boartl ot Tax Cammissioners
r T ''i�i�isYark
Information contained in ihis document is CONFIDENTIAL pursuant to IC 6-7.7-72-9. � j i
INSTRUCTIONS FOR FILING: A n�� �
..Y . ....�
To be filed in person or by mail with the County Auditor o! the county where the property is loca- %iPR �% Z�D�
ted du�ing the 72 months be%re May 11 0/ the year the deduction is to be eflective. �
Deductions lor mobile homes not assessed as real property must lile benveen January 15 app Q ^ �
Ma�ch 31. �,�, _� �,, ,!��'..,�.����
See reverse side lor additional instruction and qualilications. � �L'3�N !,���-� ��.L" ,;,-; J� (
of
nameon
contract
(owner or contiact bu^yer) �
� V`
e lega r equitable owneR I
Ye ❑ No
s ditterent tha that of applicant, ir
Iler (applicant must have been bi
""'�
r
what is hismer exaci share �
a below
on contract at �east one
D l�-0003 �� o �'
/ Assessed value of the property as
exceed $21, 000)
witn sameone
wiih whom
VEAR
spouse,
1, current year (maynot
C'Yes ❑ No
the applicant 65 years ot age or more on December 37 of the year
O Yes ❑4J�T I
IlWe certify under penalty of perjury that ihe 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
��
authorized representative
Powe� o! Attorney)