HomeMy WebLinkAboutAge_Timberlakee�'°4 AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, cour+rv TOWNSHIP YEAR
t REQUESTING DEDUCTION FROM ASSESSED VALUATION
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Sta:e Form 43708 (A / 9-96)
���1 Prescribed b the S�ate BOard ol Taa Commi55i0ners
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Information contained in this documeni is CONFIDENTIAL pursuant to IC 6-7.1-12-9.
File Mark
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INSTRUCTIONS FOR FILING: � '
To 6e liled in person or by mail with the Counry Auditor of the county where the property is loca�'•• ��-O•� -" �--*� ��� .
ted during the 72 months belore May 77 0) the year the deduction is to be effective.
Deductions lor mobile homes not assessed as real property must lile between January 75 and �'�Y� 0 i 2000
March 37. � !
See reverse side tor additional instruction and qualifications. / `� ��j %f %%
name on
Name
� �owner or
ile e1 gal or
is diHerent
seller (app
7
♦ _
ci seller
O`r�s � NO
must have
Q� (��4�
�hat is hisfier exaci share of
on contiad at least one (]) year)
Key number / Legal description
� /� ooa
� propeR4l.�sed and occupied primarily for
sr resid�tSce?
es ❑ No
the applirant 65 years of age or more on December 37 of the year
to the wrreni yeaR
etl by a survivi
time of death?
you
you
� -��
ng, unmarned spouse. what was the spouse's age a�
any other deductions?
❑Yes ❑No
deductions in any other counry?
❑ Yes ❑ No
n
If owned with someone other than spouse,
indicate with whom
Record number Page number
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$
I/We 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 7, 79 _
iature of applicant SignaWre of authonzed represeniative /by executed Powe� olAttomey)
n _ �, ./i' � i_ _ . A ..I" _ , P � .y i r A /1 �
applicant � � �Addressof