HomeMy WebLinkAboutAge_Johnson (3)rt•' AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, courm� TOWNSHIP venR
'� � REQUESTING DEDUCTION FROM ASSESSED VALUATION
�� ✓ State Fartn 43708 (R6 / 4-0a)
Presrnbed by Ne Department of Local Govemment Finance
File Mark
I�rtnalion contained in this document is CONFIDENTIAL pursuani to IC 6-1.1-'12-9 .1�qt5-9.
INSTRUCTIONS: � � �1��
To be filed in person or by mail with the CountyAuditor of the county where pP R��R�I p�erty: During the 12 months before May
the property is located. 11 f�ii��jYear the deduction is to 6e e(/eclive.
2) Mobile homes assessed underl.C.Ef-1-7;
See
on contract at least one (7) year)
Key number / Legal
-.L-q. �
V
es ❑ No
mber 31 of ihe year
es ❑ No
he spouse's age at
p Yes ❑ No
❑Yes ❑No
$744,000)
If owned wifh someone other than spouse,
indicate with whom
property
❑ Real property ❑ Mobile home (I.C. G7-1-n
property as ot March t, curtent year
ombined annual adjusted gross income of the applicant and any
sharing ovmership exceed $25,000? � �
� Yes LJ�iGO .
$
WVe certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant was a resident
of Indiana and owner of the aforemenlioned property on March 1, 20 _
� of a piicant
C'
of appliwnt _ .
�,,,,d • Y7
of authorized represeniative