HomeMy WebLinkAboutAge_Jonesae•°-'na� AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
REQUESTING OEDUCTION FROM ASSESSED
' VALUATION State Form 43708 (1-90) Prescribed by the �
�' '°�� �. State Board of Tax Commissioners n A
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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
mustfile betweenJanuary 15 and March 31. See reverseforadditional instructions
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County Township Year
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��F le , ar� �
�EB 8 1994
and qualifications. „� �,,.:� ,(i'. .S
AUDITOR
Applicant (Owner or contract er
Is applicant the sole legaior If no, what is his/her exact shar or If owned with someone other than
equitable owner? � yes O no interest? spouse, indicate with whom.
If name on record is different h n that of pplicant, indicat b o
Name of contract seller (Applicant must have been buying n con ract at le one year.)
Address of contract seller .
ing st ict Ke ega escrip Record No.
� � ' -�T�- `a� - - - -3 � Page No.
Is the real ro erty used an occupie prima i ssessed value of the property as of March 1, current
for his/her e idence? yes O no year (may not exceed $19,000).
a�v -�o�o
Was the applicant 65 years of age or more on ApplicanYs date of birth _� �(�
Dece er 31 of the year prior to the current year? �
yes O no If filed by a surviving, unmarried spouse; what was the
spouse's age at the time of death?
Does the combined annual adjusted gross Source of income Amount of income
income of the ap icant and any individuals _ L�//• %
sharing owne ip exceed $15,000? • b .� 6
O yes no
��� Total
Have you filed for any other deductions? If yes, what deductions?
Have you filed for any deductions in any other county? If yes, what county?
I/We certify under penaity 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
S� natu Authorized Representative (by executed Power of Attorney)
, , �i
ddress of Applic Address of Representative
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