HomeMy WebLinkAboutAge_Balbachej-'o AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
!�� REQUESTING DEDUCTION FROM ASSESSED VALUATION
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° State Form 43708 (R / 9�96)
'�,01—; ' Prescribed by Ihe State Board ofTax Commissioners
Information coniained in this document is CONFIDENTIAL pursuant to IC 6-7 J-72-9.
INSTRUCTIONS FOR FILING:
To be )iled in person or by mail with the County Auditor of the counry where the property is loca-
ted during the 72 months be(ore May 77 0) the year the deduction is ro be el(ective.
Deductions !or mobile homes not assessed as real propeny must li/e between January 75 and
March 37.
See reverse side for additional instruction and qualifications.
i�(o�vr�e� o� contract
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or eqmtabie owner % it No, what is hiyner exact
es ❑ No
name on
CAn[ratt 5eller l2pD�lCant mu51 flave been bW�np on
contract
S
property use
r residence?
Yes ❑ No
'as the applicant 65 years of a9e oy more on December 37 of the year
ior to the current year? //� �
y -
�plicam's date of birth (
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tiled by a surviving, unmarried spouse. whal was the spouse's age at
e time ot death?
you filed for any oiher
❑ No
you filed for deductions in any other
TOWNSHIP I YEAR
e
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1999
9E� 2� „
i wim someone other than spouse,
with whom
$
�-�� � �
❑ Yes �No �
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant was a resi-
dent of Indiana and owner of the aforementioned property on March 1, 19 �
mture of applicant SignaWre of authorized representative (by executed Power otArromey)
/{'. Qi�i..,�c� CV. .�/d��� •
so�o3ppl�nt „ � ,n� IAddress of authorized
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