HomeMy WebLinkAboutAge_Cundiff� COUNTY TOWNSHIP YEAR
AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, �
REQUESTING DEDUCTION FROM ASSESSED VALUATION
E � State Fartn 43708 (R7 / 5-OB) �
Presrnbed by the Departrnent of Local Gwemment Finarce L
OCT FileMark
�alion contained in lhis document is CONFIDENTIAL pursuant to IC 6-1.1-72-9 and IC 6-'i.i-35-9. 1 O ZOOJ
INSTRUCTIONS: FILING DATES: `�y,,
To be filed in person or by mail with the Couniy Auditor of the county where 1) Real property: FYuFi cQ�nths before �une
the property is located. 11 of theq�g t��d Q/� to be elfective.
2) Mobile homes assesse Grf�P��26-1-7-7;
See reverse side for additional instruction and qualifications. between January 75 and March 31 of the year
the deduction is to 6e effective.
�
of applinn
Q�
/// n Q
l.��c�(���
his/her exact share w i
must have been buyirg on conbad at least one
and ocapied primarity for
o �� � �a/��U�.�•O � ��
hislher residence? �
❑Yes ❑No
Was the applicant 65 years of age or rtrore on December:31 oT the year
priw to the artent year? .
�Yes ❑No
date of birth
/ _ _
-
YW
Y�
any other deduc4ons?
�Yes ❑No
deduc0ons in any other cwnty? �
I wiN someone other ihan spouse,
with whom
Is the pro erty in question: �
Real property ❑ Mobile home (I.C. 67-1-n
Record number Paqe number
Assessed value of ihe property as of March 1, wrrent year
exceed 5144.000)
�mbined annual adjusted gross income
sharing ownership exceed 525.000?
�Yes �No I
IlWe ceRify under penalty of perjury ihat the above and toregoing info�*+=i��n is true and correct and thal the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
3naWre of applicanl Signature of authorized representalive (by ezecuted Power ofAttomeyJ
I
rress of ap�
I d� � �,
of authorized