HomeMy WebLinkAboutAge_Falls��� rt., � AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, courrrv TOWNSHIP renR
` REQUESTING DEDUCTION FROM ASSESSED VALUATION --
���� State Fortn 43708 (R6 / 4-06)
- Prescribed by �he Departmeni of Lowl Govemmenl Finance
File Mark
atlon contained in this document is CONFIDENTIAL pursuant to IC 6-1.7-12-9 and IC 6-1.13&9. MA� 1 O�oOe
J
INSTRUCTIONS:
To 6e filed in person or 6y mail with the County Auditor of the county where
the property is located.
See reverse side for addi6onal instruction and qualifications.
FILING DATES:
1) Real properjy�Dunn (�,j2 months be%re May
11 of the y�af l�i`�' ediic�n is to be elfective.
2) Mo�il��eggppEBye��.C.6-1-1-7;
between January 15 and March 31 0l the yea�
the deduction is to be eNective.
Name of applicant (owne� or contract buyer) �
�
Is applicant the sole legal or equitable o If No, what is hislher exact share or interest? if owned with someone other than spouse,
' indicate with whom
Q Yes ❑ No
If name on record is diRerent than that of applicanl, indicate below
Name of contract seller (applicant must bave been buying on contract at least one (1) year)
Address of contract seller Is the property in question:
i�Real pioperty � Mobile home (I.C. 6-7-7-�
Taxing districl , Key number / Legal description Record number Page number
C?���� Q/� - ooa3��_ cro
e property used and occupied pri ari tor Assessed value of the property as of March 7, curtent year (may not
hismer residence? exceed 5744,000J
Yes ❑ No
Was the appliwnt 65 years ot age or more on December 31 of the year poes the combined annual adjusted gross income o( the appliwnt and any
prior to the current year? individuals sharing ownership exceed $25,000?
es ❑ No ❑ Yes ❑ No
ApplicanPs date of birth (month, day, year)
Have you filed for any other deductions? If Yes, what deducGons?
❑Yes ❑No
Have you filed for deductlons in any other county? If Yes, what count�?
❑Yes ❑No
1/We certify under penalty of perjury that the above and foregoing information is true and correcl and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _ .
Signature of applicant Signature of authorized representative (6y executed Power ofAttomeyJ
X L.CI
.ess of applicant Address of authorized represeniative
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