HomeMy WebLinkAboutAge_Hardiman�'` `—`�"c COUNTY TOWNSHIP YEAR
d/ s AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
-` REQUESTING DEDUCTION FROM ASSESSED VALUATION
, :
State Form a3708 (R / 9-96)
�' �',�"�, Prescribetl by the State Board of Ta. Commissioners
Information contained in ihis document is CONFIDENTIAL pursuant to IC 6-1.1-12-9. `, FiIB Mark
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INSTRUCTIONS FOR FILING: �� . ^ .; :! '. � ,�_
To be liled in person or by mail with the County Auditor ol the county where the property is loca- �
ted during the 12 months before May 77 0! the year the deduction is to be eflective. �R I 4 ZQ�Q
Deductions !or mobile homes not assessed as real property must lile between January 75 and
March 3 ). �
See reverse side !or additional instruction and qualifications. 2�,�J. _„_��
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of applicant (owner or contract buyerJ
!"l 1 . �
nameon
or equitable owner? If Nd, what is hiyher exact share of inierest?
�es ❑ No
=nt than that of applicant, indicate below
contraa seuer (appucant must
of coniract seller
��4 � �I��`�'oc�
� the property used and occupied primarily for
the applicani 65 years of age or more on
to the current yeaR
buyin9 on contract at least one (7) year)
�
with someone
with whom
Assessetl value oi ihe property as of March 1, curr2nt year
exceed $21. 000)
❑ Yes ❑ No ❑ Yes
mber 31 of the year poes the combined annual adjusted gross income of the a{
individuals sharing ownership ezceed 520,000?
pplicant's date of birth (monlh, day, year) �
��
spouse's age at
�e time of death?
you filed for any other deductions?
❑ Yes
yw tiled for deductions in any oiher wunry?
Yes, what
Yes, what
spouse,
❑ Yes C
Source ot Income Amount of
� � �
$
TOTAL $ ��
not
any
❑ Yes �-Pdo �
�
I/We 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 the aforementioned property on March 1, 19
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Address of authorized representative
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a7Attorney)
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