HomeMy WebLinkAboutAge_Debord (3)tR��:
6j�� 4 AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
a RE�UESTING DEDUCTION FROM ASSESSED VALUATION
., :
State Form 43708 (R / 9-96)
��•'�' Prestnbed by the State Board of Tax Commissioners
Information contained in this documeni is CONFIDENTIAL pursuani to IC 6-7.1-72-9.
INSTRUCTIONS FOR FILING:
To be liled in person or by mail with the County Auditor o7 the county where the property is loca-
ted during the 72 months belore May 11 0/ the yea� the deduction is to be e1/ective.
Deductions !or mobile homes not assessed as real property must lile between January 75 and
March 31.
See reverse side lor additional instruction and qualitications. ,r t, .
contrac� 6vyei)
applicantihe Solelegal
If No, what is ' exact
�-f,
�O�V�s ❑ No I
name on record is different than Ihat of applicant, indicate below
of contrect seller (applicanl must have been buying on contract at least one (1) yearJ
of contraci seller
hisfier residence?
Was ihe applicant 65 years of age or more on
prior to ihe curreni year?
AppliranYs date
�- � �
�
s
COUNTV TOWNSHIP YEAR
File Mark
,, .
2�0�
spouse,
— A55e55etl value ot ihe property a5 0� Marth 1, currQn� ye0r (maynot
exceed $27,000)
❑ Yes ❑ No ❑ Yes No
mber 37 of the year
$
I/VJe certify under penalty of perjury that the above and foregoing information is true and correct and ihat the applicant was a resi-
dent of Indiana and owner of the aforementioned property on March 1, 19
ature of�plicant Signature ot auihorized representative (by execured Power o7Attomey)
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Address of authorized representative