HomeMy WebLinkAboutAge_BeloatAFFIUAVIT OF PERSON, 65 YEARS OF AGE OR MORE, o TOWNSHIP reaa
� REQUESTING DEDUCTION FROM ASSESSED VALUATION �
S�� � State Fortn 43708 (R7 / SO6)
" Presmbed by tt�e Oeparhnent of Laal Gwemmeni Finafxe
�naUon contained in ihis document is CONFIDENTIAL oursuant to IC 6-1.1-72-9 and IC G1.135-9. OCT 1�I L�
INSTRUCTIONS: FILING DATES: '-y�� �{,��
To be frled in person or by mail with the County Auditor of the county where 1) Real property: �Juh�� 17�r�ronths 6efore June
the property is located. 11 of the
��(f�q �qnp,u(q��rg(eflective.
2) Mobile homes assessed under I.C.6-1-7-7;
See reverse side for additional instruction and qualifications. between January 15 and March 31 of the year
the deduction is to be eflective.
Name oi applicant (owner or cont
Is apptirdnt the sde legal or equtl
�
K name on record is ditferent ar
Name of mntract seller (applican
Address of contrac[ seller
T ' trid
i
s the nroceM used and occuoie�
Q ��
what is hisTher exaa share w
5'es ❑No
that of applinnt,
been buyi� on conbact at least one
> the applicant 65 years of age w more on
r to
�
dipnYs date oi b'vth (month, day, yea�)
ed by a survrving, unmartied spouse, wha�.
Ume of deaih?
ie you filed fw any other deducUOns?
number / Legal description
Yes 0 No
mber.31 of the year
DYes ❑No
was ihe spouse's age at
you filed for deductions in any other county?
I with someone other than spouse,
with whom
Is ihe property in question: � �
�Real property ❑ Mobile home Q.C. 614-n
Remrd number Page number
� ✓/• V/O
Assessed value of the property as of March 1, arrent year (may not
exceed 8744,000)
the combined annual adjusted gross income of the applicant and any
luals sharing ownership exceed $25,000?
DYes ❑No
_
� ❑Yes ❑No
IlWe certify under penatty of perjury lhat the above and foregoing info��+��� is true and cortecl and that the applicant was a residenl
of Indiana and owner of the aforementioned property on March 1, 20
� Signat�re ot applicant � Signature of authorized representative (by executed Power ofAttomeyJ
� � A /
�2ss of appli�
� ��
of