HomeMy WebLinkAboutAge_Masters,°- „_�.� � AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, couNrr TOWNSHIP venR
REQUESTING DEDUCTION FROM ASSESSED VALUATION
�O � SWte Fortn 43708 (R6 / 4-04) � '
•• Prescnbed by ihe Depanment af Local Gwemment Finance
�rtnation coniained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12•9 and IC 6-1.1-35-9.
File Mark
INSTRUCTIONS:
To be filed in person or by mail with the CountyAuditor of the county where
the propeRy is located.
See reverse side for additional insfruction and qualifications.
Is applicanl the sole legal or equiWble owne� � I(
❑ Yes O No �
If name on record is diRerent than that of applicant, Indicate below
of contract seller
Was the applicant 65 years of age or more on
prior to the cuvent year?
If filetl by a survrvil
the time of death?
spouse,
Have you filed for any other deductions?
Have you
on
at least one
Ql�
es ❑ No
December 31 of the year
es ❑ No
� �
was the spouse's age at
p Yes ❑ No
in any other countyl
❑ Yes ❑ No
or
��'
FILING DATES: t��
r1
1) Rea/ property: Dunng the 12monU�s _� ay
11 0/ the year the deduction is to be eflective.
2) Mobile homes assessed �ri�i I(F.S1�(�j� 7�
6efween January 15 and Ma�ch 31 0l he �ear
the deduction is to be effective.
,i ; �r� .Qi.�s .
someone other than spouse,
whom
Is the property in questlon:
al property ❑ Mobile home (I.C. 6-7-7-7)
escripUon Record number Page number
6 � /a-.S-o �
Assessed value of the property as of March 1, current year (may not
exceed 5744, OOOj
Does the combined annual adjusted gross incor
individuals sharing ovmership exceed 525,0007
of Income
ie ot the applicant anA any
❑ Yes �
Amount of Income
S
�
TOTAL I $
IM/e certify under penalty of perjury that the above and foregoing information is true and correct and lhat the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
807
�, m�
���f-76 �
of authorized