HomeMy WebLinkAboutAge_Bittner,n � AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, couNrr TOWNSHIP r�.R
REQUESTING DEDUCTION FROM ASSESSED VALUATION
S I Stete Fwm a3708 (R516-03)
Ptesaihed 6y ihe Departrnent of Local Govemment Finante
Information contained in ihis document is CONFIDENTIAL pursuant to IC E1.1-72-9. File Mark
�RUCTIONS: � FILING DATES:
To be filed in person or 6y mail with the County Auditor o/ [he county where 'b 1) Real property: During the 12 months before May
the property is located. ' 11 0/ the yea� fhe deduction is to be effective.
See reverse side for additional insUUCfion and qualifications.
Name of applicant
name on record
or contract buyer)
��
or equitable owneR
LLY�s ❑ No
of conVaa seller (applicant musf have been
of
residence?
seller
Was Ne applicant 65 years of age or mwe on
prior to the curtent year?
on contract at ieast one
� 2) Mo6ile homes assessed under I.C.6-1-1-7;
� between January 15 and March 37 of the year
the deduction is to be effective.
m
ir ownea Nntn someone otner tnan spouse,
indiCate wiN whom
Is the property in quesUon:
� O� 3�vO �� �❑ Real property ❑ Mobile home (I.C. 6-1•1-n
Key number / Legal description Record number Page number
' Assessed value of the property as of March 1, wrrent year (may not
exceed 8144,000)
es ❑ No
mber 37 of the year poes tha combined annual adjusted gross income of the applicant and any
� individuals sharing ownership exceed 525,000?
�(es ❑ No
ApplicanPs date of
was the spouse's age at
Ne time ot death?
Y�
you 51ed for deductions in any
❑ Yes ❑ No
❑ Yes ❑ No
�
I/VJe certify under penalty of perjury tha[ the above and foregoing information is true and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
o(Attomey)
�-�