HomeMy WebLinkAboutAge_Phillipsrt.•� 1 AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
� REQUESTING DEDUCTION FROM ASSESSED VALUATION
�O -�� State Fortn 43708 (R6 / 4-04)
Prescribed by �he Depariment of Local Govemment Finance
�rmation contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.1-35-9.
COUNTY TOWNSHIP YEAR
File Mark
INSTRUCTIONS: FILING DATES:
To be (led in person or 6y mail with the County Auditor of the county where 1) Real property: n e mo e ay
the propeRy is located. 11 0l the yea� t�d�i is to�N tiv
See 2verse side for additional instniction and qualifications.
applicant the sole legal or equitable
❑ No
name on
No, what
2) Mobi/e homes ses r
behveen January 15 and March 31 0l the year
the deduction is to be/�P¢�t�.g 2��5
share or intere�t? � If owned
indicate
of contract seller (applicant must have been buying on contract at least one (i) year)
district
Was the applicant 65 years oi age or more on
prior to Ne curtent year?
Applicant's date of
_ o Assess�al� ooe property as
exceed 8144,000)
:5 ❑ No
31 of the year
❑ No
ed by a surviving; unmarried spouse, what was the spouse's age at
time of death?
you filed for any other deducti�
you filed�for deductions in any
❑ Yes
❑ No
other than spouse,
in question:
propeRy ❑ Mabile home (I.C. Cr7-1-n
t, current year (may
combined annual adjusted gross inwme of the applicant and any
s sharing ownership exceed $25,000?
�
$
$
❑ Yes ❑ No
Amount of Ineome
I/We 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 aforementioned property on March 1, 20 _
W '
of authorized representative (by executed Powe� olAttomey)