HomeMy WebLinkAboutAge_Kennada. _ .,
dj �""o AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
-'e t RE�UESTING DEDUCTION FROM ASSESSED VALUATION
��� �� Stare Form a3708 (R / 9-96)
",y,—; ���• Prescribetl by the State BoarE of Ta. Commissioners
Information wntained in Ihis document is CONFIDENTIAL pursuant to IC 6-1.1-12-9.
INSTRUCTIONS FOR FILING:
To be �iled in person o� by mail with the County Auditor ol the county where the property is loca-
ted during the 72 months belo�e May 11 of the year the deduction is to be eflective.
Deductions !o� mobile homes not assessed as real property must lile between January 75 and
March 31.
See reverse side for additional instruction and qualilications.
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COUNTY TOWNSHIP YEAR
File Mark
:� � � ,����
i1AY 0 �' 2000
contract6uye�J � /" t�•—�= "-"`
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- � -`,.
�quitab wner? If No, what is his/her ex share of interest? If owned with someone other than spouse,
� indicate with whom
LL?'Yes ❑ No
name on record is diflerent than that ot applican
3me of wntr t seller (applicant musl have beei
/I �
on contracf a( least one (t) year)
axmg d trict Key number / Legal description Record number
'
d /3 -oo�s� dZ7
Is the property used and occupied primarily for Assessed value of the property as of Marct
hisfier residence? exceed$21,000)
es ❑ No
Was the applicani 65 years of age or more on December 31 of ihe year
prior ro the current year?
Applicanfs date
-,��
It tlletl by a surnVing, i
the time of death?
Have you filed for any
Have you filed for ded
spouse. wnat was
any
age at
❑ Yes L7'No
❑ Yes �
$
I/VJe 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 _
ature of applicant � SignaWre of authorized representative (by executed Power ofAttomey)
/- "" .�� % I Address of authorized representative
/ ��� 3 9 �� �., �-,nf�