HomeMy WebLinkAboutAge_Downsn��
� AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, couNrr TOWNSHIP v�+R
REQUESTING DEDUCTION FROM ASSESSED VALUATION -
S � State form 43708 (R5 / 6-03)
Piesaibed Ey ihe Departmeni of Lowl Govemment Finance
Infnrtnation contained in this document is CONFIDENTIA� pursuant to IC 6-1.1-12-9. -.-.� ��j File Matk
� � t� � ��.�
�fRUCTIONS: FILING DATES:
To be filed in person or by mail with the CountyAuditor of [he county where 1J Real property: Duri��the 12 moafis�efore May
the property is located. 11 of the year the deducfion is [o be effective.
2) Mobile homesassessed undeil�C.6-1-1=7; �
See reverse side /or additional insVuction and qualifications. between Janoary�l5 and7March(31.ot.the year
the deduction is to'tieieffectiJeY A!' :' �^- .
exact share or interest? Ii ownetl vnth someone olher than spouse,
indicate wiN whom
C��ces� ❑ No �
name on record is difrerent than that of applicant, indicate below
must Aave been buying on contrect at least one (1) year)
Atltlress of conVact seller
Taxing st' .
/ //pJ,17 Pa�m'7
'�e property used and occupied
r� o No
the applicant 65 years of age or more on December 31 of the year
to the current year?
es ❑ No
/
you filed for any other deductions?
you
property in quesilon:
al property ❑ Mobile home (I.C. 6-7-7-7�
Assessed value of the property as of March 1, current year (may not
ezceed $144,000J
� � aoc)
Does the combined annual adjusted gross income of the plicant and any
individuals sharing ownership exceed $25,000?
❑Yes C�lo I
any other county? If Yes, what
$ �
❑ Yes ($'�o I
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
anature of appliwnt Signature of authorized representative (by executed Power o/Attomey)
� a �,