HomeMy WebLinkAboutAge_Hapei�'aj °�"ot AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, courirv TOWNSHIP YEAR
a REDUESTING DEDUCTION FROM ASSESSED VALUATION
State Form a3708 (R / 9-96) � �
Presttibed by the S�ate Board of Tar Commissioners
� File Mark
Informa�ion contained in ihis document is CONFIDENTIAL pursuant to IC 6-1.1-72-9.
INSTRUCTIONS FOR FILING:
To be liled in person or by mail with the County Auditor ol the county where the property is loca-
ted during the 72 months belore May 7 7 of the year the deduction is to be ellective.
Deductions for mobile homes not assessed as real property must lile between January 15 and
Ma�ch 31.
� � � ,' .
3: � _ w
APR 2 6 1999
See reverse side for additional instruction and qualifications. � D
� �
Namebf applicam (owner contract buyer) .( ��"" -"
GiBSON �Ut�7Y AUDITOR
d- S �_ - 2 - -�
Is applicant the sole legal or quit � ner? tl No, what is his/her e a t share of interest? If owned with someone other than spouse,
�� indicate with whom
❑Ye� ❑No
If name on record is diHerem than ihat ot applicant, indicate below
Name of contraci seller (applicant must have been buying on contract at least one (1) year)
Address of contraci seller
l�- -i - o�-- .3aa-ea�
Taxing district , Key number / Legal descripiion Record number Page number
. — ..__ --_—� —.
��. 1 _ —
Is t e property used and occupied primarily for Assessed value of the propeny as ot March 1, curreni year (may not
his/her residence? exceed $21,000)
❑ Yes ❑ No ❑ Yes �
Was the applicant 65 years of age or more on December 37 ot ihe year poes the combined annual adjusted gross income of the applicant and y
prior to the curreni year? individuals sharing ownership exceed 520,000?
❑ Yes o
Applicant'
� SS $
If filed by a surviving, unmarried spouse, what was ihe spouse's age at $
the time of death?
TOTAL $
Have you filed tor any other deductions? If Yes. what deductions?
❑ Yes ❑ No
Have you filed for deductions in any other rnunty? If Yes. what counry?
❑ Yes ❑ No
I/VJe certify under penalty of 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 applicani SignaWre of authorized represemative (by execured PowerolAnomeyJ
V' �
ress of applicant Address of authorized representative
2 2 I t3.� � l