HomeMy WebLinkAboutAge_Sharpej—"o AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE� COUNTY TOWNSHIP VEAR
�a ' REQUESTING DEDUCTION FROM ASSESSED VALUATION
���' Sta;e Fortn a3708 (fi / 9-96)
'� 'q„ •'� PresCnbed by ihe State Board ol Tax Commissioners
File Mark
Information coniained in this documeni is CONFIDENTIAL pursuani to IC 6-7.7-12-9.
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INSTRUCTIONS FOR FILING j�' � �� iE� �� �
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To be liled in person or by mail with the Counry Auditor of the county where the property is loca-
ted during the 72 months before May 77 0! the year the deduciion is to be elfective. %�R Q l Z�Q�
Deductions lor mobile homes not assessed as real properry must tile between January 75 and
March 31.
See reverse side for additional instruction and qualilications. :��N `� �./�(�/
/� ::IqQ:}�f I':.L�A!T`/ �e�
owner? If No, what is hisfner exact are of interest? If owned with someone other than spouse,
indicate with whom
❑ Yes ❑ No
If name on record is difleren� than ihat of applicant, indicate below
Name of contran seller (applicant must have been buying on con(iac� a� least one (7) year)
Address of contraci seller
�xing district Key number / Legal description Record number Page number
o��-�ys��- � .
Is ihe property used and occupied primarily for Assessed value ot the property as ol March 1, cunent year (may nof
hisRier residence? exceed 321.000)
❑ Yes ❑ No ❑ Yes .❑ No
Was the applicant 65 years oi e r more on December 31 of the year poes the combined annual adjusted 8ross income of the applicaN and any
prior to the current yeaR individuals sharing ownership exceed $20,000? ���
❑ Yes Lyrco
Applicant's date of birth (monlh, day, year) Source of Income Amount o1 Ineome
l5 S $
If filed by a surviving, unmarried spouse, what was ihe spouse's age at $
the time of deaih?
TOTAL $
Have you filed for any other deductions? If Yes, whai deduciions?
❑ Yes C�'I�lo
Have you filed for deduciions in any o,her couniy? If Yes, what counry?
❑ Yes C'L�'IVo
I/We certify under penalty of perjury that the above and toregoing information is true and correct and that the applicant was a resi- ,
dent of Indiana and owner of the aforemeniioned property on March 1, 79
Signature f applicam Signature of authorized represemative (6y executed Power o1AtlomeyJ 4�
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dress ot applicant Address of authorized representative