HomeMy WebLinkAboutAge_Freudenberg.K,.
'�AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
REQUESTING DEDUCTION FROM ASSESSED VALUATION
S�w % Slate Form 43708 (R7 / 5-06)
Presrnbed by tlie DeQartrnent W Laal Gwemment Finance
��malion contained in Ihis documeni is CONFIDENTIAL pursuant to IC 61.1-12-9 and �C 6-1.7-35-9.
COUNTV TOWNSHIP YEAR
i
INSTRUCr10NS: FILINGDATES: OCT 1 1 Z00%
To 6e filed in person or by mail with the County Auditor ol the county where 1) Real pioperty: d)u�ng the 12 months 6efore June
the property is /ocated. il o( the year cd� o be eHective.
2) Mo6ile 1����s u� I.C.6-1-1-7;
See reverse side /o� additional instruction and qualifications. between January �YA�}i�i�Rif the year
the deduction is to be effective.
ame of appGpnt (owner w oonhad bu//ye��� � �y �/
�^��l/!/-'l/"vy �/ ���(�Z'�,'/"° ` _ "" (/ G
applicant the sole legal or equitable ovmeR If No, what is his�her exact
❑Y� oNo
name on remrd is diRerenl than Mat af applirant, indinte below
of mntract
of conVact seller
P�P�nY use
r residence7
must
primarily for
m conhad at leasf one
D`J
Is the property
-ao-r�f-3�3-oDo.oa.� -oo�.
❑Yes ❑No
the applicant 65 years of age or mae on Decembec 31 oi the year
to the wrtent year?
� ❑No
pnPs
d by a surviving, unmartied spouse, what was the spouse's age at
me of deathl
you filed fw any other
you filed for deductions in any
❑Yes ❑No.
❑Yes ❑No
exceed
I with someone other Nan spouse,
WIU1 W�lOffl
'� Real property � Mobile home (I.C. 6-1-1-n
Record number Page number
ihe properry as of March 7, current year
_
IlWe certify under penalty of perjury tha[ the above and foregoing info�**��r��n is We and correct and thal the applicant was a resident
of Indiana and owner of the aforemen[ioned property on March 1, 20 _
V
representative (byexecuted
representative
e