HomeMy WebLinkAboutAge_Graper�,.__ .• � AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
°`\ ' REQUESTING DEDUCTION FROM ASSESSED VALUATION
�'� � State fortn 43708 (R6 / 4-Oa) � '
•• Prestnbed by the DepaNnent ol local Govemment Finance
�rmation wntained in ihis document is CONFIDENTIAL oursuant to IC 6-1.'I-72-9 and IC 6-1.1-359
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor ol the county where
the p�opeRy is located.
See �everse side (or additional instruction and qualifications.
! ° ill �iQ�s� • � ��!'
', '' � 11
FILING DATES: p•� 6� � V1�p�T�R
t) Real prope����M�in�nths 6efore May
11 of the ye e deduction is to be eflective.
2) Mo6ile homes assessed under 1.C.6-1-1-7;
6etween January 15 and March 31 of the year
the deduction is to be eflective.
Name of applicant (ownei or contrac� r) � �
Is applicant the sole legal or equitable owne� If No, what is hislhe exad share or interest? If owned with someone other than spouse,
• indiwte with whom
❑Yes ❑No
If name on record is difierent fhan that of applicanC indiwte below
Name of wntract seller (applicant must have been buying on contracf af leasf one (7f year)
Address o( contraci seiler Is the property in question:
❑ Real property ❑ Mobile home (I.C. 6-7-7-�
T' district � Key number / Legal desaiption Rewrd number Page number
� -3 _ . I -
Is the property u ed and occupied pri arity for
Have you filed for any oNer deductions? If Yes, what deducdons?
❑ Yes ❑ No
Have you filed for deductlons in any other wunty? If Yes, what county?
❑Yes ONo
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 aforementioned property on March 1, 20 _
Signature of appiicant SignaNre of aulhorized representative (6y executed Power oJAttomeyJ
x '^�CJ O�LJ�'� �
ress of apPlicant Address of authorized representative
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