HomeMy WebLinkAboutAge_Doerner;,��.• � AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
' REQUESTING DEDUCTION FROM ASSESSED VALUATION
���.� Sute Form 43708 (R6 / 4-04)
Preuribed by Ne Department of Local Govemment Finance
�rmatlon contained in this document is CONFIDENTIAL pursuani to IC 6-1.1-12-9 and IC 6-1.1-359.
INSTRUCTIONS:
To be �led in person or by mail with the County Auditor of the county where
the propeRy is located.
See reverse side fo� additional instruction and quali(cations.
of applicant (owner or contract
applicant the sole IAgal or equitable owner? If No, what is
�res ❑ No
name on record is difterent than that of applicant, indicate below
contract
ot contract seller
and occupied primarily tor
65 years of age or more on
year?
of birth (monfh, day, year)
��-
etl by a surnhng, unmarrietl spouse, what was
Ume ot death?
you Lled for any other deductions?
you filed for deductions in any olher county?
on contract at least one
or
COUNTY TOWNSHIP YEAR
�
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�� '• .� 11V �/�
� i�.e .5..1 1
File Mark
AUG 1 ?� zuu4
FILING DATES: � /
1J Real pro�Ry Dunng tbe 12imonths.�efo�May
11 o/the�yea��tlie`.deduction is to be eyective.
2J Mobile homes assessed unde� I.C.E1-1J;
6etween January 15 and March 31 0l the year
fhe deduction is to 6e eHective.
isomeone
whom
Is the propeAy in question:
�'Real property ❑ Mobile home (I.C. 6-i-7-n
number / Legal descripiion Rewrd number Page number
❑ Yes ❑ No
mber 3'I of ihe year
❑ Yes ❑ No
�
he spouse's age a
❑ Yes ❑ No
❑ Yes ❑ No
the property as of March 1, curtent year (may not
�mbinetl annual atljustetl gwss Incom�
I/We certify 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 aforemenlioned property on March 1, 20 _
�%
Address of authorized representative