HomeMy WebLinkAboutAge_Harvey°` °�" AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
�` �`. RE�UESTING DEDUCTION FROM ASSESSED VALUATION
��• State Form 43708 (R / 9-96)
� �' Prescribed by the State Boartl ofTaM Commissioners
Information contained in this document is CONFIDENTIAL pursuarn to IC 6-1.1-12-9.
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 72 months before May 77 of the year the deduction is to be eflective.
COUNTY I TOWNSHIP
�� �t F���'�
�' .7 _ �
MAR � 1 2000
Deductions !or mo6ile homes not assessed as real property must lile between January 15 and � i
March 37. . f/•,��_� ���
See reverse side lor additional instruction and qualilications. " /�' ,=�' •' ' �• _�•'-�.+ •�r-�� � � c;�-.-�;; �
YEAR
Name of applicant (ow e� oi contract buyer) � %/ �
, � ��"�7�QilC
Is applicant the sole gal or equitable er. I No, whai is is/her ex ct share ot interest? If owned with someone other than spouse.
indicate with whom
❑Ye ONo
If name on record is difterent than that of applicant, indicate below
Name of contract seller (applicant mus( have been buying on contiact a( least one (7) year)
Address of contract seller
�ing disirict Key number / Legal description Record number Page number
p�9- o��o � c�
Is the property used and occupied pnmarily for Assessed value of the property as of March 1, current year (may not
hisfier residence? exceed $27,000)
❑ Yes ❑ No ❑ Yes ❑ No
Was the applicani 65 years ot age or more on December 37 of the year
$
Have you filed for any other deductions? If Yes. what deductions?
❑Yes ❑NO I
Have you tiled for deductions in any oiher county? If Yes. what counry? -
1
❑Yes ❑No
I/We 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, 79
ISignature of applicani Signature of authorized representative (by executed Power ol Attomey)
ddress of applicant Address of authorized representative
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