HomeMy WebLinkAboutAge_Thompson (3)d�n•"'°a� AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
s REQUESTING DEDUCTION FROM ASSESSED
VALUATION State Form 43708 (1-90) Prescribed by the
I�•• � State Board of Tax Commissioners
uctions 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 reverse foradditional instructions
and qualifications.
County �, Township
MAY 4 1993
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AUDITOR �'
Year
Applicant (Owner�contract buyer
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Is applicant the sole legal�er-- If no, what is his/her exact share or I owned wi h someone other than
equitable owner? O yes 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 seller
ing Distr t Key Number/Legal Descri tion Record No.
� Q� _ �—d(� Page No.
he real property used and o cupied primarily Assessed value of the property as of March 1, current
r his/her residence? �O no year (may not exceed $19,000).
Was the applicant 65 years of age or more on ApplicanYs date of birth _/
es 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 applicant and any individuals �-----
sharing owners exceed $15,000?
O yes o
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?
IlVJe 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
��nature Authorized Representative (by executed Power of Attorney)
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A�ddress of Applicant Address of Representative