HomeMy WebLinkAboutAge_James(!
,°� _ n n g AFPIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, courm TOWNSHIP venR
" REQUESTING DEDUCTION FROM ASSESSED VALUATION /f
�O � SUte Form 43708 (R6 / C-OC) � /�
•• Prescnbed by ihe Depanment of Lowl Gwemment Finance D
File Mark
,.�ormation contained in this document is CONFIDENTIAL pursuani to IC 6•1.1•12-9 and IC 6-1.1•35-9. APR . 9 Z00�
INSTRUCTIONS FILING DATES:
To be filed in person or 6y mail with the Counry Auditor o/ the county where
the p�operty is located.
See reverse side for additional instruction and qualiTCations.
1) Real properry: ' the�7 r�ionths be(ore May
11 0/ the yea� t e e hon ��o be etfective.
2) Mobile i�ytgp5ydlfGnA@}d1Qi�^=1-1-7;
between January 15 and March 31 of the year
the deduction is to be effective.
Name of applicant owner or contract buyer) '
Is applicant the sole legal or equitable o er. If No, what is his/her exacf share or interest? If owned with someone other than spouse,
indicate with whom .
Yes ❑ No
If name on record is dlRerent n that of applicant, indicate below
Name of contract seller (applicant must have been buying on confracf af least one (7) year)
Address ot conVact seller � Is the property in question:
�
�-/ 3- l9- � oa - o o D, /,f9 - oo s Real property � Mobile home (/.C. 6• 7-7-7)
Taxing distnct Key number / Legal description Record number Page number
•
� � �
Is the property used and occupied primarity for Assessed value of the property as of March 1, current year (may not
hisRier residence? exceed 5744,000)
❑ Yes ❑ No
Was the appliwnt 65 years ot age or more on December 31 of the year poes the combined annual adjusted gross income of the appiicant and any
prior to the wrtent yearl individuals sharing ownership exceed 525,0001
❑ Yes ❑ No O Yes ❑ No
Applicanl's date of birth (month, day, year)
C����e%Y,C(,��1�Q� Yes ❑ No
Have you filed for deductions in any other wunty? If Yes, what count�
❑Yes �No
IIVJe certify under penalty of perjury fhat the above and foregoing information is true and correct and that the applicant was a residen{
of Indiana and owner of the aforementioned property on March 1, 20 _
Signature of applicant Signature o( authorized representative (by executed Power ofAttomeyf
CZM'a---+i � .
ress of applicant Address of aulhorized representalive
�, / � � � �C