HomeMy WebLinkAboutAge_Hunt (3)' e•°'°a AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
.° � REQUESTING DEDUCTION FROM ASSESSED County Township Year
°� �, VALUATION State Form 43708 (1-90) Prescribed by the n
��^�•"� State Board of Tax Commissioners p Ih
l.� �J
Instructions for filing: ark
To be filed in person or by mail with the County Auditor of the County where the T �
property is located during the 12 months before May 11 of the year the deduction �� �A -i .
is to be effective. Deductions for mobile homes not assessed as real property �AY 1� 19g6
mustfile betweenJanuary 15 and March 31. See reverseforadditional instructions
..a ,. .,�,�,,..,.;,,.,�
...... .... ................. ,(f . Ji� .s
Applicant (Owner or contract bu er)
Is applicant the sole le or If no, what is his/her exact share or If owned with someone other than
equitable owner? es O no interest? spouse, indicate with whom.
If name on record is different than that of applicant, indicate below:
Name of contract seller (Applicant must have been buying on contract at least one (1) year.)
Address of contract seller
��T n District Key Number/Legal Description Record No.
� �� — -(9O 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 ❑ no year (may not exceed $19,000).
C�
Was th applicant 65 years of age or more on ApplicanYs date of birth
Dec ber 31 of the year prior to the current year? �—�
yes �7 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 Source of income Amount of income
income of the a plicant and any individuals 3 8.0�
sharing owne hip exceed $15,000? S S
7 yes no �
Total
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 appli-
cant was a resident of Indiana and owner of the aforementioned property on March 1, 19
S�ature Authorized Representative (by executed Power of Attorney)
Address of Applicant Address of Representative
.