HomeMy WebLinkAboutAge_Shaw'l�ai �''� AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
` RE�UESTING DEDUCTION FROM ASSESSED VALUATION
�• State Form a3708 (F / 9-96)
"' PreSCribeC Dy the Siate Boartl of Ta� Commissioners
Information wntained in this document is CONFIDENTIAI pursuant to IC 6-1.1-72-9.
INSTRUCrIONS FOR FILING:
To be liled in person or by mail with the County Auditor o7 the county where the property is loca
ted during the 72 months before May 77 0/ the year the deduction is to be eflective.
Deductions lor mobile homes not assessed as real property must file between January 75 and
March 31.
See reverse side !or additional instruction and qualilications.
nameon
contract
contract
� / '
or equitabie owner? If No, what is hiy er exaci sh
es ❑ No
=nt t n ihai of applicant, indicate below
oolicant must have been buvinq on contracf at least one
is me propeny useo ano occupiea pnmarny mr
his/her residence?
es O No
Was the applicant 65 years of age or more on December 31 of the year
prior to the current year?
Applicant's date ot
If filed bya surviving, unmarried spouse, what was the spouse's age at
ihe time ot death?
you filed (or any other
Yes ❑ No
you filed for deductions in any oiher
exceed $21,000)
t��l:�#:: -P_\
���1 ��'�.�
$ �:.
� `
F. `
'# � '�'�.
r_
MAY 0 6 1999
spouse,
indiCate with whom
property as of March 1, current year (may not
Does the combin2tl annual atljus[etl gross fncor
individuals sharing ownership exceed 520.000?
of Income
�- � $
$
TOTAL $
❑ Yes No
d the applicam and any
❑ Yes No
Amount of Ineome
�035.0
❑ Yes �'No
�
I/VJe certify under penalty of perjury ihat the above and foregoing information is true and correct and that ihe applicant was a resi-
dent of Indiana and owner of the aforementioned property on March 1, 19
ature ot applicant � SignaNre of authorizetl representative (by executed Power olAttomey) 1
of applicant I Address of authorized