HomeMy WebLinkAboutAge_Huffi_n •? AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
l " REQUESTING DEDUCTION FROM ASSESSED VALUATION
�° ,��� � Stata Fortn 43708 (R614-0a) �
Prascnbed by the Department o1 Local Gavemment Flnance
�ormation wntained in this document is CONFIDENTIAL pursuant to IC 6-1.�-12-9 and IC &1.7359.
INSTRUCTIONS:
To be filed in person or 6y mail wifh the CountyAuditor of the county where
the propeRy is located.
See �everse side tor additional instruction and qualifications.
COUNTY TOWNSHIP YEAR
� le a c�
FIUNG DATES: �UN 1 I ZOO�
1) Real property: During fhe 12 months 6e(ore May
11 of the yea�Vje�de,d�i0n is to be effective.
2J Mobile hom� a`ssessed�erl.C.6-1•1-7;
betwe�IB�bh��S�Eyrd/vt�{�A ofthe year
the deduction is to be el/ective.
Name of applicant (owner or contrect buyer)
Is applicant the sole legal or equitable ow�er? If No, wha er exact share or Interest? If owned with someone other than spouse,
' . indicate with whom
❑Yes ❑No
If name on rewrd is diRerent than that of appliwnt, indicate below I
Name of wntrect seller (applicanf must have been buying on confrsct at least one (1) year)
Address of conVact seller Is the property in question:
Real property ❑ Mobile home (I.C. 6-1•1-7)
Taxin district Key number / Legal description Record number Page number
/.� oaT DZIJ•��`940
Is the property used and occupied prima ' i r Assessed value of the property as of March 7, current year (may not
hismer residence? � exceed $744,000J
❑ Yes ❑ No
Was the applicant 65 years of age or more on December 37 of fhe year poes the combined annual adjusted gross income of lhe applicant and any
prior to the curtent yearl individuals sharing ownership exceed 525,0001
❑ Yes ❑ No ❑ Yes O No
ApplicanCs
what was Ne spouse's age at $
the time of death?
TOTAL $
Have you filed tor any other deductions? If Yes, what deductlons?
❑ Yes ❑ No
Have you filed for deducdons in any other countyl If Yes, what county?
❑ Yes ❑ No
IMIe certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant was a residenf, I
of Indiana and owner of the aforemenlioned property on March 7, 20 _
� Signature of applicant Signature of authorized representative (by executed Power olAffomey)
�ress o�nt ���� �J Address of authorized represenlative
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