HomeMy WebLinkAboutAge_Strawy., ,rt.n � AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
REQUESTING DEDUCTION FROM ASSESSED VALUATION
�� .� State Fortn 43708 (R6 / s-Oa) '
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Presrnbed by ihe Department of Lowl Govemment Finance
�rmation contained in this documenl is CONFIDENTIAL pursuant to IC 6-7.1-12•9 and IC 6-1.1-35-9.
INSTRUCTIONS:
To be filed in person or by mail with the CountyAuditor of the county where
the property is located.
See reverse side fo� additional instruction and quali(cations.
COUNTY TOWNSHIP YEAR
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��Fil'e Mark
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FILING DATES:I S / �7
1) Real propeTty�:l�ufingttle�,7months before May
11 0( the ye r fhe deduction is to be ef/ective.
2) Mobile hom����ces���der 1.C.6-1-1-7;
he d���Mfl �rTU'����M�a�e 3�1 of the year
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If name on rewrd is diRerent an that of applicant, indicate below
Name of contrect selier (applkanf must bave 6een buying on conGact at Ieast one (i) year)
Address of conVact seller Is th�perty in question:
Real property ❑ Mobile home (I.C. 6-1•7-7)
Taxing district Key number / Legal description Record number Page number
1-6-17 �Id.-7�o�l-000, 5�9-0�
Is lhe property used and occupied primarity for Assessed value o( the property as of March 1, curtent year (may not
hisRier residence? �/ exceed 5744,000)
,L�IYes ❑ No
Was fhe appiiwnt 65 years ot age or more on December 37 of fhe year poes the combined annual adjusted gross income of the applicant and any
priw to the current year7 individuals sharing ownership exceed 525,0007
Yes ❑ No ❑
Have you filed for any oNer deductions7 If Yes, what deductlons?
❑ Yes ❑ No
Have you filed (or deductians in any other county? If Yes, whal countyl
❑ Yes ❑ No
I/We certity under penalty of perjury that the above and foregoing information is true and correct and that the applicani was a resident
of Indiana and owner of the atorementioned property on March t, 20 _
Signature of appliwnt Signature of aulhorized representative (by exetuted Power ofAttomey)
ress of applicant Address of aulhorized representative
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