HomeMy WebLinkAboutAge_Thomas�.•°'"o AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
-°�.y�' REQUESTING DEDUCTION FROM ASSESSED
VALUATION State Form 43708 (1-90) Prescribed by the
•• � 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
propertyis located during the 12 months before May 11 of the year the deduction
is to be effective. Deductions for mobile homes not assessed as real property
mustfile betweenJanuary 15 and March 31. See reverse foradditional instructions
and qualifications.
Applicant (Owner or
f�AV � � 1994
�
Is applicant the sole leg o��R no, what is his/her exact sh2ire or If owned with someone other than
equitable owner? es O no I 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
Address of contract seller
Is the real property used an ccupie
for his/her residence? es O no
Was the applicant 65 years of age or more on
Dece er 31 of the year prior to the current year?
yes ❑ no
Does the combined annual adjusted gross
income of the ap � ant and any individuals
sharing owne ip exceed $15,000?
O yes � no
Have you filed for any other
Have you filed for any deductions in any other county?
on contract at least one (1) year
J � Page No.
Assessed value of the property as of March 1, current
year (may not exceed $19,000). ,
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I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the appli-
cant was a resident of Indiana and owner of the aforeme�tioned property on March 1, 19
SrR�ature �_ n Authorized Representative (by executed Power of Attomey)
of Representative