HomeMy WebLinkAboutAge_Blanton.;
.A°'"� AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, � �*
e t County Township Year
REQUESTING DEDUCTION FROM ASSESSEDj��� ,ii., J
° , VALUATION State Form 43708 (1-90) Prescribed by the[�� F'' "–
��•^ �� State Board of Tax Commissioners „�i 2 igg8
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Instructions for filing:
To be filed in person or by mail with the County Auditor of the County whe e the �—�1`p
property is located during the 12 months before May 11 of the year the deductioriJa ca'�
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is to be effective. Deductions for mobile homes not assessed as real property
mustfile betweenJanuary 15and March 31. See reverseforadditionai instructions
and qualifications.
Applicant (Owner contract uyef)
Is applica e le I al or If no, what is his/her exact share or If owned with someone other than
equitab e� yes O no interest? spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: ,
Name of contract seller (Applicant must have been buying on contract at least one (1) year.)
Address of contract seller
lo-v 5-J`� - 0(�� - . 03 la - o
ing Distr ct Key Number/Le al Description__ _ Record No.
r" _�.b=QQ Page No.
Is the I property used and occupied primarily Assessed value of the property as of March 1, current
for his/her residence? ❑ yes O no year (may not exceed $19,000).
Was the pplicant 65 years of age or more on ApplicanYs date of birth ^ _
Dece er 31 of the year prior to the current year?
es O no If filed by a surviving, unmarried spouse, what was the
spouse's age at the time of death?
Does the combined annual adjusted gross Source of income Amount of income
income of the ap ant and any individuals S
sharing owner ip exceed $15,000?
❑ yes o D • DO
Total
Have you filed for any other deductions? If yes, what deductions?
Have you filed for any deductions in any other county? If yes, what county?
I/We certify under penalty of pe�jury that the above and foregoing information is true and correct and that the appli-
cant was a resident of Indiana and owner of the aforementioned property on March 1, 19 '
Siqnature Authorized Representative (by executed Power of Attorney) �
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Address of Applicant Address of Representative
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