HomeMy WebLinkAboutAge_Campbellaa�°'TM4,� ,AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
REQUESTING DEDUCTION FROM ASSESSED
i; ' �'� !'
VALUATION State Form 43708 (1-90) Prescribed by the
In�•� State Board of Tax Commissioners
uctions 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
mustfilebetweenJanuary 15and March 31. See reverseforadditional instructions
and qualifications.
Applicant (Owner or contract
Is applicant the sole legal or
equitable owner? � es ❑ no
If name on record
Name of contract
Address of contract seller
than
If no, what is his/her exact share or
interest?
of
must
al Description
r� r� �, n
Is the real property used and upied primarily
for his/her residence? es O no
Was the plicant 65 years of age or more on
Dec ber 31 of the year prior to the current year?
• yes ❑ no
Does the combined ual adjusted gross
income of the ap cant and any individuals
sharing owne ip exceed $15,000?
❑ yes r no
Have you filed for any other deductions?
Have you filed for any deductions in any other county?
on
County Township Year
� I �
File Mark
������
�1NR 0 3 1995
If owned wifi someone other than
spouse, indicate with whom.
least one (1)
J � Page No.
Assessed value of the property as of March 1, current
year (may not exceed $19,000).
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 and owner of the aforementioned property on March 1, 19
Authorized Representative (by executed Power of Attorney) I,
ress of Applicant / � � Address of Representative