HomeMy WebLinkAboutAge_Cloind�•°'°v$ AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
p REQUESTING DEDUCTION FROM ASSESSED
' VALUATION State Form 43708 (1-90) Prescribed,by the
�^� � State Board of Tax Commissioners
�
Instructions for filing:
To be filed in person or by mail with the County Auditor of the County where the
property is located during the 12 months before May 11 of the year the deduction
is to be effective. Deductions for mobile homes not assessed as real property
must file between January 15 and March 31. See reverse for additional instruc ns
and qualifications.
G18SON
Applicant (Owner or
Is applicant the sole leg r If no, what is his/her exact share or
equitable owner? � es O no interest?
If name on record is different than that of applicant, indicate below:
Name of contract seller (Applicant must have been buying on contract at
Address of contract seller
District
Is the real,property used
for his/her residence? [
Key Number/Legal
O no
Was�applicant 65 years of age or more on
Dec ber 31 of the year prior to the current year?
yes �] no
Does the combined annual adjusted gross
income of the appl ant and any individuals
sharing owners p exceed $15,000?
�� yes o
Have you filed for any
?
Have you filed for any deductions in any other county?
County Township Year
�ark
�
MAY 12 1997
If owned with someone other than
spouse, indicate with whom.
one (1) year
Page No.
Assessed value of the property as of March 1, current
year (may not exceed $19,000).
ApplicanYs date of birth
If filed by a surviving, unmarried spouse, what was the
spouse's age at the time ef death?
Source of income Amount of income
Total
If yes, what deductions?
If yes, what county?
I/We certify under penalty of perjury 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 Attor�,y)
r
�-/�-, �n �.
Address of Applicant
��2..r c/ �
,
Address of Representative