HomeMy WebLinkAboutAge_Hogga•°'"o AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
a y� REQUESTING DEDUCTION.FROM ASSESSED
' VALUATION.State Form 43708 (1-90) Prescribed.by_the
°• ' State Board of,Taz Commissioners •
� .
Instructions for filing:
To be filed in. person or-by mail with the Gounty Auditor of the County where 1he
property is located during the 12 months before May 11 of the year the deduction
is to be effective. Deductions for mobile homes not assessed as real property
mustfilebetweenJanuary 15 and March 31. See reverse foradditional instructions
and qualifications.
County � Township� Year
�FEB 26 1996
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AUDITOR
Applicant (Owner or contract r) � �
Is applicant the sole legal or � If no, what is hi er exact share o f owned with someone other than
equitable owner? O yes '�'Fio interest? spouse, indicate with whom. .
If name on record is different than at of pli nt, indicate below:
Name of contract seller (Applicant must have been buying on contract at least one (1) year.)
Address of contract seller
�ci ,_ i ' Key mb /Leg I D1e�s1cri t8i n Record No. �
a�� � � ���" � lo� � l— Q � Page No.
Is the real property used a occupied primarily Assessed value of the property as of March 1, current
for his/her residence? yes �7 no year (may not exceed $19,000).
Was the icant 65 years of age or more on ApplicanYs date of birth
Dec er 31 of the year prior to the current year?
yes O no If filed by a surviving, unmarried spouse, what was the
spouse's age at the time of death?
Does the combined annual adjusted gross
�
Have you filed for any other deductions? If yes, what deductions?
Have you filed for any deductions in any other county? If yes, what county?
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the appll-
cant was a resident of Indiana and owner of the aforementioned property on March 1, 19
�nature Authorized Representative (by executeii Power of Attorney)
Address of F{p I� ant Address of Representative
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