HomeMy WebLinkAboutAge_Dodsondj �'�"a AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, couNrv TOWNSHIP VEAR
a t RE�UESTING DEDUCTION FROM ASSESSED VALUATION
e .
Stare Form 43708 (R / 9-96)
�'� �' PreStribed by the State Board of Tac Cammissioners
Fi�p�
Informa�ion contained in this document is CONFIDENTIAL pursuant to IC 6-1 J-12-9. �'`! q���
INSTRUCTIONS FOR FILING: 7 �� J���
To be liled in person or by mail with the County Audito� o/ tbe counry where ihe property is loca-
ted du�inq the 72 months before May 7 7 of the year the deduction is to be el(ective. �% ��.���
Deductions lor mobile homes not assessed as real propeRy must lile between January 15 and
March 31_
See reverse side (or additional instruction and qualilications. �-w.�i 1
. �.' ` :c."ln}(1VJ T•� I.il71T��
name on
contraa
Address of contract seller
district
or contract buyerJ
R
or uitable owneR f
es ❑ No
:nt than at of applicant, in
oolicant must have been ba
Is ihe property used and occupied primarily for
his/her residence?
on conrracr ar /east one (7) year)
number /
❑Yes ❑No
ihe applicam 65 years of age or more on December 37 of the year
ro ihe current year?
ApplicanYs date of birth (month, day, �ea�J
��- - �
If tiled by a survivinq, unmarried spouse, what was the spouse's age at
Ihe time ot death?
you ined ror any
LTj'es ❑ No
you filed for deductions in any other county?
If owned with someone other ihan spouse,
indicate with whom
number
number
1 \ l^C�`C) I I
Assessed value ot ihe property as of March 7, curtent year (may nor
exceed 521,000)
❑ Yes �lo
Does ihe combined annual adjusted gross income of the applica t and any
individuals sharinq ownership exceed 520.000?
O Yes � I
I/VJe certiiy under penalty of perjury that the above and foregoing information is true and correct and that ihe app�icant was a resi-
dent of Indiana and owner of the aforementioned property on March 1, 19
.
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