HomeMy WebLinkAboutAge_Cartere�"'^a � AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
°� � � REQUESTING DEDUCTION FROM ASSESSED
�� � VALUATION State Form 43708 (1-90) Prescribed by the
•• � State Board of Tax Commissioners
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Instructions for filing:
To be filed in person or by mail with the County Auditor of the County where the
property is located during the 12 months before May 11 of the year the deduction
is to be effective. Deductions for mobile homes not assessed as real property
mustfile betweenJanuary 15and March 31. See reverseforadditional instructions
and qualifications.
Applicant (Own� contract
County Township Year
I ` �
File Mark
������
MAY 0 7 1997 `
Is applicant the sole le if no, what is his/her exact shar�r If owned with someone other than .
equitable owner? yes ❑ no interest? spouse, indicate with whom.
If name on record is different than that of applicant, indicate below:
Name of contract
Address of contract seller
icant must have been buying on contract at least one (1) year.)
Is the real property used a occupied primarily
for his/her residence? yes O no
Was the icant 65 years of age or more on
Dece er 31 of the year prior to the current year?
yes O no
Does the combined ann f�adjusted gross
income of the appli t and any individuals
sharing owner p exceed $15,000?
❑ yes no
you filed for any other deductions?
Have you filed for any deductions in any other county?
` � U � Page No.
Assessed value of the property as of March 1, current
year (may not exceed $19,000).
ApplicanYs date of birth /� _� � _ � � �
If filed by a surviving, unmarried spouse, what was the
spouse's age at the time of death?
Total
If yes, what
If yes, what county?
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the appli-
cant was a resident of Indiana and owner of the aforementioned property on March 1, 19
Si nature Authorized Representative (by executed Power of Aftorney)
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Address of Representative
9�,y S. ��in��
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