No preview available
Age_Gardnerae�"•°o� AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, REQUESTING DEDUCTION FROM ASSESSED _ � VALUATION State Form 43708 (1-90) Prescribed by the �' �°�� �� State Board of Tax Commissioners li`�luctions 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 mustfile betweenJanuary 15and March 31. See reverseforadditional instructions � �� � �� ' '' ��f1� � --- r ��_ :�..-� �{, ; J � F. i ! w �- � ���1i1991 and qualifications. 01`�I-0 BO—oc� Ap ' ant (Owner o c ntract b yer) UDITOR ,�. Is ap ' ant the sole legator If no, wh t his/her exact share or If owned with someone other than equitable owner? �es O no interest? spouse, indicate with whom. If name on record is different than that of applicant, indicate below: Name of contract seller (Applicant must have been buying on contract at least one (1) year.) Address of contract seiler Ta trict K umber/Le Des iptio Record No. � Page No. Is me real perty used a� occupied primarily Assessed value of the property as of March 1, current for his/her residence? �9'yes ❑ no year (may not exceed $19,000). ,� Was the applicant 65 years of age or more on ApplicanYs date of birth _ Dec ber 31 of the year prior to the curreni year? yes ❑ no If filed by a surviving, unmarried spouse, what was the spouse's age at the time of death? Does the combined annual adjusted gross Sour of income Amount of income income of the applicant and any individuals sharing owne ip exceed $15,000? � O yes � Total -� Have you filed for any other deductions? If yes, what deductions? Have you filed for any deductions in any other county? If yes, what county? 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 Signature Authorized Representative (by executed Power of Attorney) � ,%4.i�� / _ � Address of Applicant Address of Representative sa� �� .G���� . ��