HomeMy WebLinkAboutAge_Fulton•n
� AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
° REQUESTING DEDUCTION FROM ASSESSED VALUATION
�> � Sfate Fwm 43708 (R516-03)
�N
Prescn6ed by Ne Departman[ of Local Govemment Finance
Infortnation wnWined in this dowment is CONFIDENTIAL pursuant to IC 6-7.7-12-9.
�
COUNTY TOWNSHIP YEAR
File Mark
UCTIONS: FILING DATES:
To be �led in person o� by mail with the County Auditor of the county where 1) Real property: Dunng the 12 months be/o�e May
the property is located. 11 0( the year the'deduc'tion is to be eHective
See reverse side for additional instruction and qualifications.
applicant (owner or
name on
Name of conVaa seller
residence?
�
or epuita o � If No
Yes ❑ No
ent n at of applicant, indica
ipplic nt must have been buyinc
tha applicant 65 years of age or more on
to lhe current year?
If filed by a surviving, unmartied spouse, what was the spouse's age at
the tlme of death?
Have you filed for any other deductions?
❑ Yes �o
Have you flled for deductions in any other county?
❑Yes ❑No
$ �
❑ Yes � �
IIWe certify under penalty of perjury that the above and foregoing informalion is true and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
3nature of appiicant Signature of auNorized representative (by executed Powe� o/Attomey)
� �� Address of authorized representative