HomeMy WebLinkAboutAge_Kramer� rt•� � AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
`° = REQUESTING DEDUCTION FROM ASSESSED VALUATION
t��w ! State Fortn 43708 (R4 / 10-07 )
Prescribed �y Ne Department of Loral Govemment Finance
�nation contained in this document is CONFIDENTIAL pursuant to IC 6-7.1-12-9.
COUNTY TOWNSHIP YEAR
File Mark �,
INSTRUCTIONS: FILING DATES:
To be Fled in person or by mail with the County Auditor o/ the county where 1) Real property: Dunng the 12 montF,s before May
the property is /ocated. 11 0/ the year the deduction is to 6e effective.
2) Mobile homes assessed underl.C.6-i-1J;
See reverse side foradditional ins6uction and qualifications. between January 15 and March 31 olthe year
the dedust+pn,is to be effestive.,r�
Name of
Is
3nt (owner or cont2ct buyer)
[
sole legal or equita e owner.
�] Yes ❑ No
If name on rewrd is
at wutrhct seller
exact share or interest?
must have been buying on confracf at least one
number / Lega� description
and occupied primarily (or
O Yes ❑ No
Was the applicant 65 years of age or more on December 31 0( the year
prior to ihe current year?
ihe time c
Have you
Have you
Yes ❑ No
date of birth (month, day, year)
—�
surriving, unmarried spouse, what was the
death?
any
❑ Yes
deductions in any other county?
age
ezceed $69, 000J
I�AK O 1 2002
I wiih someonep�her than spouse,
with whorn /
Is the property in question:
pmperty ❑ Mobile home (I.C. 614-�
property as of Marrh 1, cuvent year (may not
Does the combined annual adjusted gmss inwme
individuals sharing ownership exceed 525,000?
❑ Yes � No I
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant was a resi-
deM of I' na and owner of ihe aforemenlioned property on March 1, 20 _
aNre ap � nt _� �( \ SignaNre of authorized representative (by executed Power o/Aftomey)
/l )
C:l t/i) t� �
�ess of applipnt
'� � �� ����