HomeMy WebLinkAboutAge_Hunterdj �''o AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
d � RE�UESTWG DEDUCTION FROM ASSESSED VALUATION
L�
� Siate Form 43708 (R / 9-96)
`,�,� '� Prescnbed by t�e Siate Board ofTax Commissioners
Information comained in this document is CONFIDENTIAL pursuant to IC 6-7 J-12-9.
INSTRUCTIONS FOR FILING:
To be tiled in person or by mail with the County Auditor o/ the county where the propeRy is loca-
ted during the 72 months be%�e May 71 of the year the deduction is to be ef(ective.
Deductions lor mo6ile homes not assessed as real property must file between January 75 and
March 37.
See reverse side fo� additional insiruction and qualilications.
(owner or
' � \
Is applicant the sole legal or equitable ow ?/ I If No, what is his/her exact share of interest?
V
Yes ❑ No
If name on record is ditterent than that of applicant, indicate below
Name of contraa seller (applicant must have been buying on cronrract at /east one (1) year)
of contract seller
property use
r residence?
th0 applicant 65 year5 oi age or more on
to the current yeaR
/
filed by a surviving, unmarried spouse. what was
e time of death?
you filed for any oiher
you filed for deductions in any other
number
❑ Yes
•�1�� • -
/ ��1
� /�
,� � .
�` � � � .
_ y :i
} £ .
k:
APR 16 19gg
someone other
whom
r � -� �`�% �
As essed value of the property as of March 7, current year
� exceed 527.000)
❑ No ❑ Yes
he year poes the combined annual adjusted gross income of the aF
individuals sharing ownership exceed $20,000?
p Yes
age ai
❑ No
)�
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant was a resi-
dem of Indiana and owner of the aforementioned property on March 1, 79 _
ure of apblicant / ,� Signature of auihorized representative (by executed Power o7Attomey)
of authorized representative
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