Age_Burkhart. .
ej='"ot AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
-� REQUESTING DEDUCTION FROM ASSESSED VALUATION
i:
Stare Form 43708 (R / 9-96)
�" l Prescnbed by the Stare 9oard ol Ta� Commissioners
Information wntained in ihis document is CONFIDENTIAL pursuani ro IC 6-7.7-12-9.
INSTRUCTIONS FOR FILING:
To be liled in person or by mail with the County Auditor of the county where the p�operty is loca-
ted during the 12 months be)ore May 71 0/ the year the deduction is to be ellective.
Deductions for mobile homes not assessed as real property must fi/e beRveen January 75 and
Ma�ch 37.
See reverse side lor additional instruction and qualilications.
Name of napplicar
�
Is applicant the s�
If name on recort
Name of wntract
(owner or cont�act buyer)
��-ll�n �i� /i �
le legal or equitable owner. If o, what is
�s ❑ No
is diHerent Ihan thai of applicant, indicate below
contract
Is ihe property use
his/her residence?
(applican( musl have been buying on cronfract at least one (t) year)
Ihe applicani 65 years ot age or more on
to the current year?
tl filed by a
the time of
Have you filed tor any
Have you
COUNTY TOWNSHIP YEAR
File Mark•
�•t� �� --�i �
ri,�r u 5 1999
;� �%
.. . � j
l° Gf�� $pi, 4'J'J; 7� Y AUD
If owned with someone other than spouse,
indiCate with whom
Key number / Legal description Recnrd number Page number
r - - �� �"a ��a. r _�—.
�� � Assessed value oftfie property as of March 7, currem year (may not
exceed $27, 000)
❑ Yes ❑ No ❑ Yes C�.M6
mber 37 of the year poes the combined annual adjusted gross income of ihe applicant and any
individuals sharing ownership exceed 520,000?
�
,�,-�...
spouse, what was ihe spouse's age at
uctions?
❑ Yes �'I l�o
any other couniy?
❑ Yes �do
I/We certify under penalty o( perjury that the above and foregoing information is irue and correct and that the applicant was a resi-
dent of Indiana and owner of the aforementioned property on March 1, 19
nature ot appucant ' , ` ��
�.� _ � // /f� ��i��/�/"
G'^��L
�ress ol applicant �
�°� �