HomeMy WebLinkAboutAge_Brown''rt •'� AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
�°'•
°� � REQUESTING DEDUCTION FROM ASSESSED VALUATIO�
'� � State Fortn 43708 (R6 / 4-04)
Prescribed by ihe Depanment of Local Govemment Finance
�nation contained in this dxument is CONFIDENTIAL pursuant to IC 6-7.7-12-9 and IC Cr1.7-35-9.
INSTRUCTIONS:
To be filed in person or 6y mail with the CountyAuditor of the counfy where
the propeRy is located.
See reverse side for additional instruction and quali(cations.
COUNTY TOWNSHIP YEAR
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MAY 1 0 2005 Fi�e r�tark
FILING DATES:
1) Re�pi�ipert� the 12 months belore May
(;d� �h he duction is to be effective.
2�1Vl�'�1e �Ya���nderl.C.6-1-1-7;
6etween January 15 and March 31 of the year
the deduction is to 6e e/fective.
Name of applicant (owner or contract buyerJ � I
n
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Is applicant the sole legal or equitab e owner? If No, what is his/her exact share or interesl? If owned with someone other than spouse,
• indicate with whom
�es ❑ No
I( name on record is difterent than that of appiicant, indiwie below
Name of contract seller (app/icant must have been buying on contract at least one (1J year)
Address o( conVact seller Is the property in question:
eai property ❑ Mobile home (I.G GiJ-7)
Taxing disUict Key number! Legal descriptlon Record number Page number
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� property used and occupied primarity for Assessed value of the property as of March 1, current year (may not
IhisRier residence? exceed 3144,000)
es ❑ No
Was the applicant 65 years of age or more on December 37 of the year
Have you filed for any other deducUons? If Yes, what deductions?
• ❑ Yes No
Have you filed for deductions in any olher county? If Yes, what county7
❑ Yes o
WJe certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
Signatur o pp' ni Signature of authorized representative (6y executed Power ofAttomey)
'YI
ress of applicant . Address of authorized representative
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