HomeMy WebLinkAboutAge_Luigs,;re,...,,
,.. `� AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
REQUESTING DEDUCTION FROM ASSESSED VALUATION
�> + State Form 43708 (R614-04)
Prescnbed by Ihe Department of Local Govemment Finance
�aatlon contained in this document is CONfIDENTIAL pursuant to IC 6-1.7-12-9 and IC 6-1.1-35-9.
INSTRUCTIONS:
To 6e filed in person or by mail with the County Auditor of the county where
the propeRy is located.
See reverse side (o� additronal instruction and qualifications.
FILING DATES
1) Real property: D�l}�h� th� � r�6Bjs before May
11 0( the year the deduction is to be effective.
2) Mobile homes assessed undecl.C.Gi-1-7;
6efween Janua�f5�d �lNa��i 31 of fhe yea�
the deduc�ir��to ��'v&�OITOR
If No, what is his/her exact share or interes . If owned with someone other than spouse,
' indicate with whom
❑ Yes ❑ No
If name on rewrd is diRerent than ihat oi appliwnt, indicate below
Name of contrap seller (applicanf must have been buying on contract at least one (7) year) •
�"---- ---- •-^' �� r C� Is the property in queslion:
���
���O ���� Real property ❑ Mobile home (I.C. 6-7-7-�
Taxing district Key number / Legal description Record number Page number
O��' C�C.�T�U � !I�
Is the property used and occupie primarily for Assessed value o( the property as of March 1, current year (may not
hisfier residence? exceed 5744,000)
❑ Yes � No
Was the appliwnt 65 years of age or more on December 31 oi ihe year
$
Have you filed for any other deductions? if Yes, what deductions?
❑ Yes ❑ No
Have you filed for deductions in any other wunty? If Yes, what county?
❑ Yes ❑ No
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that lhe applicant was a resident
of Indiana and owner of lhe aforemenlioned property on March 1, 20 _ •
SignaW of applicant Signature of aulhorized representative (by exE�uted Power ofAttomey)
v ''
ss of appliwnt Address of authorized representative
`�- ( � S . � ao�f- �
`��6�9