HomeMy WebLinkAboutAge_Marshn,. � AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
REQUESTING DEDUCTION FROM ASSESSED VALUATION
S,w� � State Fortn 43708 (RS / fi-03)
Presuibed by Ne Depamnent of �ocal Govemment Financa
Infortnation conWined in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9.
�TRUCTIONS:
To be filed in person or by mail with the County Auditor o! the county where
the property is located.
See reverse side /or additional instiuction and qualificafions.
Name of applipnt (owner
or
❑Yes ❑No �
name oo record is different than that oi applicant, indicate below
convan
exact share w
must have been buying on confracf at least one (1) }rearJ
1G✓�
and occupiefl pnmarily
�s ❑ No
Was the applicant 65 years of age or more on December 31 of the year
prior to the current year?
L7 Yes ❑ No
If filed by a
Ihe Ume of
you
you
�
❑ Yes DNo
❑ Yes l3'No
COUNTY TOWNSHIP YEAR
File Mark
FILING DAT S;i � ~
1) Realp rty: �ri_ the 1� nt��tbre May
11 of the year the deductions fo��8'eflective.
2) Mobile homes_a�,ss,essed u�,�{# C.6-1-1-7;
between January 15 and A•Tdi�M31 0/ the year
fhe deduction is to be eNective.
Y"
If owned wiN someone ot�er than spouse,
indicate wiN whom
property in quest
Real property
Assesse0 value ot Ne property as of
exceed $144,000J
aG 900
Does the combined annual adjusted
individuals sharing ovmership excee
what counry?
❑ Mobile home (I.C. 6-1-1-�
Page number
1, curtent year (may not
icome of tha appficant and any
DO?
� Yes QNr�
Amount of Income
� � �
s am� __
TOTAL I 5 �
IIVJe 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 _
�
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