HomeMy WebLinkAboutAge_Kell�•"-'TM4 AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
a�. �`, REQUESTING DEDUCTION FROM ASSESSED
VALUATION State Form 43708 (1-90) Prescribed by the
� ,e
° State Board of Tax Commissioners
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 reai property
mustfile betweenJanuary 15and March 31. See reverseforadditional instructions
and qualifications.
Applicant (Owner or
Is applicant the sole legal r If no, what is his/her exact share or
equitable owner? � es O no interest?
If name on record is different than that of applicant, indicate below:
Name of contract seller (Applicant must have been buying on contract at
Address of contract seller
Is the real pr�rty used
for his/her re ence? (
O no
Description
Was the applicant 65 years of age or more on
December 31 he year prior to the current year?
❑ yes no
Does the combined annual adjusted gross
income of the ap ant and any individuals
sharing owner ip exceed $15,000?
O yes no
you fiied for any other ded
Have you filed for any deductions in any other county?
� �B > > 1998
If owried rroith someone other than
spouse, indicate with whom.
one (1) year.)
Record No.
Page No.
Assessed value of the property as of March 1, current
year (may not exceed $19,000).
ApplicanYs date of birth �_�
If filed by a surviving, unmarried spouse, what was the
spouse's age at the time of death?
If yes, what deductions?
If yes, what county?
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the appli-
cant was a resident of Indiana nd owner of the aforementioned property on March t, 19
Signature Authorized Representative (by executed Power of Attorney)
�� w ,
iress of Applicant ' I Address of Representative
s-2 z s,�O-� �� d �.