HomeMy WebLinkAboutAge_Carithersaj �"o AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
a t REQUESTING DEDUCTION FROM ASSESSED VALUATION
�(� . � Slate Form 43708 (R / 9-96)
�)a„� ��, Prescribed by ihe Slate Boartl of Tae Commissioners
Intormation contained in Ihis document is CONFIDENTIAL pursuant to IC 6-7.1-12-9.
INSTRUCTIONS FOR FILING:
To be liled in person or by mail with the County Auditor ol the county where the property is loca-
ted during the 72 months before May 77 0l the year the deduction is to be el(ective.
Deductions lor mobile homes not assessed as real property must lile beRVeen January i5 and
March 31.
See reverse side tor additional instruction and qualifications.
COUNTV I TOWNSHIP I YEAR
ANR 19 1999
,�� �COUW7Y AUDITOR
ame of applicant (own o� contract buye�) '(�^ f
� � ' ' I lJ�-�/I� � � -
applicant the sole le or equitabl owner? If No, whai is his/her exact share of interest? If owned with someone other than spouse.
� indiCate with whom
❑Yes ❑No
name on record is differem than that of applicanL indicate below
comract
contract
,��
Is the property use
his/her residence?
Was the applicam
prior to ihe currem
AppliranYs
spouse, what was the spouse'S age at
you tiled for any other deduciions?
O Yes O No
you filed for deductions in any other
vir
what
Yes, what
❑ Yes ❑ No
Source of Income emount ef Ineome
$ 4Z9`�.o0
$ 3336• Oo
- TOTAL s �y�_oa
❑ Yes ❑ No �
I/VJe certify under penalty of perjury that the above and foregoing information is true and correct and that the applicani was a resi-
dent oi Indiana and owner of the aforementioned property on March 1, 19
ature of applirant Signature of authorized representative (by executed Power o/Attomey)
A /1 .n . , �
of applicanV - Address of authorized representative
� � � ���9-- ���� , ?6 2C�