HomeMy WebLinkAboutAge_Dunigan�n
F AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
REQUESTING DEDUCTION FROM ASSESSED VALUATION
S � Stata Fam 43708 (R5/ 6-03)
�N�
Prewihed by the Department of local Govemment Finance
Infortnation conWined in Nis document is CONFIDENTIAL pursuant to IC fr1.7-12-9.
�RUCTIONS:
To be flled in person or by mail with the County Auditor of the counfy where
the property is located.
See reverse side (or additional instruction and qualifications.
or
name on record is diRerent
contract
Yes ❑ No �
that of applicant, indirate below
must have been buying on contract
�
Was lhe applicant 65 years of ayE or more on
prior to the current year? �
spouse, what was the spouse's age ai
in any other counry?
❑ Yes
❑ Yes
$ �
IIVJe certify under penalty of perjury that ihe above and foregoing information is true and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _ .
gnatu�enf applicant n ` � Signature of authorized representative @y executed Power ofAttomey)
Address of authorized