HomeMy WebLinkAboutAge_Romershausene•"-'^4� AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
a °��REQUESTING DEDUCTION FROM ASSESSED
y VALUATION State Form 43708 (1-90) Prescribed by the
i °• ��' State Board of Tax Commissioners
�
Instructions for filing:
To be filed in person or by mail with the County Auditor of the County where the
property is located during the 12 months before May 11 of the year the deduction
County � Township
MAY 0 2 1997
is to be effective. Deductions for mobile homes not assessed as real property /
must file between January 15 and March 31. See reverse for additional instructions/���` �— I
and qualifications. �,.,,.,,, ,,,, T„ ;;
C,,..t , Ini7QR :
Year
Applica t(Owner or contract buyer)
j � Q<-c,4Q/���
Is applicant the so legal or If no, what is his/h�ac� share or If owned with someone other than
equitable owner? �yes ❑ no interest? spouse, indicate with whom.
If name on record is different than that of applicant, indicate below:
Name of contract seller (Applicant must have been buying on contract at least one (1) year.)
N �
Address of contract seller
c�'� /q�9- o�aa -�� ��3� - a�6
in9,District • Key Number Legal_Oescciption ecord o.
i' {� (D_/_/_O./-dS �—D•O � 0�'I -0 0'J e o.
Is the real prop rty used and occupied primarily A essed value o property as of March 1, current
for his/her residence? �7yes O no year may not exceed $19,000).
Was the applicant 65 years of age or more on
Have you filed for any other deductions? If yes, what deductions?
0
Have you filed for any deductions in any other county? A 1� If yes, what county?
� �.
I/We certify under penalty of perjury that the above and foregoing information is true and cbrrect and that the appli-
cant was a resident of Indiana and owner of the aforementioned property on March 1, 19
�� nature Authorized Representative (by executed Power of Attorney)
� f / .:
i�
Address o p ant 6 Address of Representative .
,p� .�vx i7
7