HomeMy WebLinkAboutAge_Foxdj `"'v AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
�'` = RE'QUESTING DEDUCTION FROM ASSESSED VALUATION
�• State Porm a3708 (R / 9-96)
'�.,—:- •�, Prescribetl by the State Boartl of TaM Commissioners
Information contained in ihis document is CONFIDENTIAL pursuant to IC 6-1.7-72-9.
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INSTRUCTIONSFORFILING: NOV O� �999
To be liled in person or by mail with the County Auditor ol the county where the property is loca-
ted during the 72 months before May 11 of the year the deduction is to be eflective.
Deductions !or mobile homes not assessed as real property must lile between January 75 and
March 31. GIE°ON� TY AU�I70R
See reverse side (or additional instruction and qualifications_
Name of appli9 -' '----- or conr�act buyer)
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Is applicant tne so�e ��y.., ... :quitable owner? If No. w�iher ezact share of
�s ❑ No I
name on record is difterent ihan that of applicant, indicate below
wntrad
property use
r residence?
Was the
prior to i
mus! have been
65 years of age or more on
year?
ApplicanPs date ot
the spouse's age ai
the time of death?
you filed for any other deductions?
you filed for deductions in any other crounry?
L�'�es
❑ Yes
one
wlth SOmBOfIB
with whom
SPOU58,
number
Assessetl value of the property as of March 7, curreni year (may not
exceed 527.000)
f��Yes ❑ No
Does Ihe combined annual adjusted yross inwme of Ihe applicant and any
individuals sharing ownership exceed 520,000?
Souree of Ineome
$
5
TOTAL S
If Yes, what deductions?
❑No ���
�If Yes. what couniy?
■-.
❑ Yes � No
Amountoflncome
,l
I/VJe certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant was a resi=
dent of Indiana and owner of ihe aforementioned property on March 1, 19
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