Age_Carnahan" t AFFIDAVIT OF PERSON� 65 YEARS OF AGE OR MORE� coUNTY TOWNSHIP YEAR
':: -„;; REQUESTING DEDUCTION FROM ASSESSED VALUATION
� State Form 47708 (R3! 8-00)
� ���
Prescribed by iha State Board of Tax Commissioners
�•. File Mark
ahon contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-72-9. ��
INSTRUCTIONS FOR FILING: � j� � � �
To be filed rn person or by mail with the Co�nty Auditor of the county where the property is loca- g
ted dunng the 12 months before May 11 0/ the year the deduction is to be effective.
Deductions lor mo6ile homes not assessed as 2a1 property must file between January 15 and MAY 0 9 2001
March 31.
See reverse side for additional instruction and qualifications. � �,�,., Q, Il
��r_-f�=�l �, �
Is appliwnt the sole legal or equitable wne�? If No, what is
[�'S'es O No
If name on record is dit�erent than that of appliwnt, indipte below
of contrad seller
if i� ��JC�r� �1
Is the real property used and occupied
primarily tor his/her residence?
the applicant 65 years ot age or more on
to the current yearl
on contract at
Yes ❑ No
mber 37 at Ne year
C�3'i'es ❑ No
filed by a surv'rving, unmarried spouse, what was the spouse's age at
e time of death?
Have you filed for any other deductions?
you
any
C7 Yes ❑ No
� Yes �vo
or
one (1J year)
I wilh someone other
with whom
number
spouse,
value oflfie properly as of March 1, curtent year (may not
s,000)
�o ��
pmbined annual adjusted gross income of ihe applicant and any
�, sharing ownership exceed $25,000?
Source of Income
$
$
TOTAL $
If Yes, what deduttions?
r��� ��
❑ Yes {ef'No
Amaunt ot Income
C
INVe certify under penalty of perjury �that the above and foregoing information is true and correct and that the applicant was a resi-
dent of Indiana and owner of the aforementioned property on March 1, 20 _ '
atu� of a�qplicant Signature of authorized representalive (by executed Power o7Attomey)
>s of appllcant
2 �d - �m -� S-�_ �rt�: �.
representative