HomeMy WebLinkAboutAge_Sweezer�� n�h 0
e��ts
:,
� reis .
� 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
Instructions 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
must file between January 15 and March 31. See reverse for additional instructions
County Township Year
. `�
/
File Mark
; ;
; a ' �-. ;'?
� ,
�'• � ��
and qualifications.
Applicant (Owner or ntrac bu er) n,� _ ___ oN_i ou TY AUDITOR
`.el
Is applicant the sole le r If no, what is hi her exact share or If owned with someone other than
equitable owner? yes O no interest? spouse, indicate with whom.
If name on record is different than that of applicant, indicat elow: �'fG' �� —09
Name of contract seller (Applicant must have been buying on contract at least one (1) year.)
Address of contract seller
�• r�g Disf ey Number/Legal Description Record No.
i� — = _a— - � - Q� Page No.
Is the real property used a ccupied primarily Assessed value of the property as of March 1, current
for his/her residence? ' yes O no year (may not exceed $19,000).
Was the �cant 65 years of age or more on ApplicanYs date of birth `
Dece er 31 of the year prior to the current year? .
� yes O 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 Source of income Amount of income
income of the app nt and any individuals �
sharing owner ip exceed $�;@8@? R n .
O yes � no ao- °O � � rT
Total g a Q Q. Q Q
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)
_ �
Address of Applicant Address of Representative
� CS�G�•�1sir��� � y7� S