HomeMy WebLinkAboutAge_Dishonej °''o: AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, cour+TV TOWNSHIP YEAR
! - REQUESTING DEDUCTION FROM ASSESSED VALUATION
. .
'+ State Form 43708 (R / 9-96) ...����ppp �
�"'�,�;;--�` Preuribetl by the State Board of Ta. Commissioners �� � 1 �
°•-` ""` � � File Mark
Intormation contained in ihis document is CONFIDENTIAL pursuant to IC 6-7.1-72-9. � ,,,,��
INSTRUCTIONSFORFILING: APR �` / nLWV
To be li/ed in pe�son or by mail with the County Auditor ol the county whe�e the pro erty is loca- /(�
ted dwing the 72 months before May 77 0l the year the deduction is to be e/fectiv . �'> L
Deductions for mobile homes not assessed as real property must file between Ja ��iSa�U��1Y al,ul,On
March3l. �;; ��350N'� T
See reverse side for additional instruction and quali(ications.
ame of applicani (owner or
C
applicani ihe sole legal or
name on record is ditterent
ame of contraa seller (app�
]dress of contract seller
❑ Yes ❑ No
mu51 have been bW�np on COntraGt at lea5t one
��4 r I CJ I"I —
ie property used and occupied primarily for
her residence?
❑Yes ❑No
> the applicant 65 years of age or more on December 37 ot the year
r to ihe current year?
JicanPs date of birth (month, day, yearJ
ed by a survivin9, unmarried spouse. what was the spouse's age at
time of death?
�e you filed for any other deductions?
❑Yes ❑No
�e yw tiled for detluctions in any other counry?
❑Yes ❑No
I Wlth SOm20nB
with whom
number
spouse,
number
ad value of ihe property as of March 1, wrrent year /maynot
$2t.000)
❑ Yes ❑ No
e combined annual adjusted gross income of the applicant and an
als sharing ownership exceed 520,000?
❑ Yes o
$
IIVJe 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 aoolirant l\ �. I Sianature of authorized reoresentative !bv execu(ed Powei olAttomevl
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