HomeMy WebLinkAboutAge_J & J Douglas Trust�rt•n� COUNTY TOWNSHIP YEAR
� AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
�� � � REQUESTING DEDUCTION FROM ASSESSED VALUATION
� •w � Slate Fortn 43708 (R4 / 10-07 )
�_
Prescribed by Ihe Department ol Local Govemment Finance
File Mark
.. aGOn wntained in this document is CONFIDENTIAL pursuanf lo IC 6-7.1-12-9. �
INSTRUCTIONS: FI ���S�� Y
To be �led in person or by mail wifh the County Auditor o/ the county where 1 a e_ n e 12 months 6elore Ma
fhe property is located. 1 the ear the de n is to be e/%ctive
See reverse side for additional insfruction and qualifications.
�� —
Name o( applicarlKowner or contract bwQr) i
Is appiicanl the sffe legal or
It name on
contract seller
of contrad seller
It No,
❑ Yes ❑ No
below
must have been buying on cont�act at least one
number / Legal description
D�y� ❑ No
Was ihe applicant 65 years of age or more on December 31 of lhe year
prior to the wrrent year?
❑ Yes ❑ No
ApplicanPS date
��-�
If fded by a surviving, unmarried spouse, what was Ihe spouse's age at
the time o( death?
you nied tor any
❑Yes ❑No
Have you filed for deductions in any other county?
$69,000J
2) Mobile hgi�� �ss�9s9�'dLnde�l.C.�1-1-7;
behveen'January 15�and Mar�h 3n1 of the year
G�gSON
I with someone olher than spouse,
WIUI V' .•
Is the property in queshu�
❑ Real pmperty ❑ Mobile home (I.C. 614-n
property as of Marrh 1, current year (may nof
the com6ined annual adjusted gross income of the applicant and any
fuals shanng ownership exceed 525,000?
❑ Yes ❑ No
$
❑ Yes ❑ No �
1/We certity under penalty of perjury that the above and foregoing information is true and correct and that the applicant was a resi-
denl of Indiana and owner of the aforementioned propeAy on March t, 20
ature o( applicant �', Signalure of authorized representative (by executed Power oJAttomeyJ
of