HomeMy WebLinkAboutAge_Runze'�"" } AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
.-- �; REQUESTING DEDUCTION FROM ASSESSED VALUATION
• � State Form 43708 (R3/ &00)
.� u J
PrescribeC by ihe State Board of Tan Commissbners
In�ation contained in this dowment is CONFIDENTIAL pursuant to IC 6-7.1-12-9.
INSTRUCTIONS FOR FILING:
To be (led in person or by mail with the County Auditor o/ the county where fhe property is loca-
ted dunng the 12 months be(ore May 11 of the year the deduction is to be eHective.
Deductions /or mobile homes not assessed as real praperty must file 6etween January 15 and
March 31.
See �everse side /or additional instruction and qualifica6ons.
applidnt (ownerorcontrect
the sole legal or equitable owneY? \ylf No,
❑ Yes O No �
It name on rewrd is diRerent than that of applicant, indicate below
ot conlract seller (applicant must have been buying on
contraG seller
'as the appiiwnt es years oi age or more on uea
ior to Ne wrreni year7
pplipnfs date
filed by a surv'rv��, unmarried spouse, what was
e time of death7
you filed for any other deductions?
you
any
7�s ❑ No
mber 37 ot year
es ❑ No
age at
O Yes ❑ No
share or inlerest?
one
MAY 0 7 2001
GIB� TY AUDITOR
It ownetl wlt� someone other than spouse,
indicate with whom
Page number
Ne property as of March 1, wrrent year
�mbinea annua� aCJustetl gross income ot lhe applicant and any
sharing ownership exceed 825.000?
� Yes o
Source of Income Amount of Income
Yes, what deductions?
$
$
TOTAL $
❑ Yes ❑ No �
I/We ceRify under penalty of perjury �that the above and foregoing information is true and correct and thal the applicant was a resi-
dent of Indiana and owner of lhe aforementioned property on March 1, 20 _
aturey�i appliwnt ,.� _ Signature of authorized representative (by executed PowerofAttomey)
applicant
authorized representative
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