HomeMy WebLinkAboutAge_Evansdj R''o AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
` ' REQUESTING DEDUCTION FROM ASSESSED VALUATION
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Stare Form 43708 (R / 9-96)
�`,�,—� '�"�a PreSCnbeC bY Ihe Sta;e Board of 7a. Commissioners
Inlormation contained in this document is CONFIDENTIAL pursuan� to IC 6-1.7 -12-9.
COUNTY TOWNSHIP YEAR
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Fil�
�p � ? 2000
INSTRUCTIONS FOR FILING:
To be liled in person o� by mail with the County Audito� o! the county where the property is l�� �
ted during the 72 months be)ore May t 1 0/ the year the deduction is to be eflective. /,> �,,. . �
Deductions /or mobile homes not assessed as real property must lile between January 15 and J��� C�JT;� �,�, �
March 31. L�" �"
See reverse side lor additional instruction and qualifications.
Name of appiicant (owner oi conhacr buyer)
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Is applicani ihe sole legal or eq le owner? If No. what is hi5lher e t share ot interesi? If ownetl with someone oiher than spouse,
indicate with whom
Yes ❑ No
If name on record is diKerent ihan that of applicani, indicate below
Name of contract seller (applicant must have been buyinq on crontrac( at least one (1 J yearJ
Address of contraci seller
nng �'ct Key number / Legal description Record number Page number
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Is the property used and occupied primarily tor Assessed value of the propeny as of March 1, current year (maynot
his/her residence? exceed $21.000)
❑ Yes ❑ No ❑ Yes ❑ No
Was the applicant 65 years of age or more on December 37 of ihe year
$
Have you filed tor any other deductions? If Yes. what deductions?
❑ Yes ❑ No
Have you filed for deductions in any other county? If Ves, what couniy?
❑ Yes ❑ No
I/VJe certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant was a resi-
dent of indiana and owner of the aforementioned property on March 1, 19
Signature of applicani Signature ot authorized represeniative (6y executed Power olAttomey)
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. dress of appli t Address of auihorized represemative
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