HomeMy WebLinkAboutAge_Goebel...,,
,, ,_. 4 AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, courm TOWNSHIP venR
" REQUESTING DEDUCTION FROM ASSESSED VALUATION
1 � State Fortn 43708 (R6 ! 4-Oa) �
Prescnbed by Ne Department ol Local Gavemment Finance
� File Mark
TNiormation contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6•1.7-359.
INSTRUCTIONS:
To be fifed in person or 6y mail with the CountyAuditor of the county where
the property is located.
See �everse side !o� additional instruction and quali�cations.
the sole
name on
wntrect seller
residence?
! l..C.i_.Y� �
or equitable ovmeR
Yes O No
If No, what is his/her exact share or interest?
musf have been 6uying on contract at feasf one (f)
�i,Yes ❑ No
the applicant 65 years of age or more on December 31 of the year
ro the wrtent year?
�Yes O No
:d by a surviving, unmarried spouse, what was the spouse's age at
dme of death�
you filed for any other deduciions?
you filed
in any other countyl
❑ Yes
❑ Yes
FILING D rES.� � � �
E
1) Real propeRy: During fhe 12 mon s before May
11 0/ fhe ye� c�e���N i�s to 6e ef/ective.
2) Mo6ile homes ass� e 9er I.C.6-1-1-7;
between Jaa�rya 15 and March 31 of the year
the deductios�(a`�.be�f�stive.
u owned vnth someone
indicate with whom
Is the property in question:
spouse,
❑ Real property ❑ Mobile home (I.C. 6-7-7-7)
Record number Page number
�tl value of the property as of March 1, curtent year (may not
$144, 000)
i �' �f-OL�
�mbmed annuai aa�ustea gross �ncome
sharing ovmership exceed 525,0007
I/We ceRify 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 propeAy on March 1, 20 _ �
/
�✓
�4 / �.C�ll°�dCd `/i/
��6 �9
of authorized representative