HomeMy WebLinkAboutAge_Janesej"�'o AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
d ' REQUESTING DEDUCTION FROM ASSESSED VALUATION
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�� Stare Porm 43708 (R / 9-96)
j�,—,� �`"��, Prescribetl by Ihe Stare Boartl ot Tax Commissioners
Information wntained in this document i5 CONFIDENTIAL pursuant to IC 6-7.1-72-9.
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INSTRUCTIONS FOR FILING: APR O I �999
To be )iled in person or by mail with the County Auditor ol the county where the property is loca-
ted during the 72 months belore May 77 0/ the year the deduction is to be ellective.
Deductions lor mobile homes not assessed as real property must lile between January 15 and
March 31. GIBSO�i
See reverse side for additional instruction and qualifications. U TY AUDITOR
Name of applicant (owne� or co trac buyP�) •
Is applicant the sole legal or equitable owner? If No, what is his/her exact share ot interest? If owned with omeone other ihan spouse,
indiCate with hom
Yes ❑ No
If name on record is diNereni than that of applicant, indicate below
Name of contraa seiler (applicant must have been buying on conhact at least one (1) year)
Address of contract seller
g�strict Key number / Legal description Record number Page number
' -C�U`��0-00
Is ihe property used and occupied primarily for Assessed value of the property as of March 1, current year (maynot
his/her residence? exceed 521.000)
Yes ❑ No ❑ Yes o
Was the applicant 65 years of age or more on December 37 of the year poes the combined annual adjusted gross income of ihe applicant and any
prior to the curreni year? individuals sharing ownership ezceed 520.000?
O Yes ❑ No
Applirant'
Have you filed for any other deductions? If Yes, what deductions?
Yes ❑ No
Have you filed for deductions in any oiher county? If Yes, what counry?
O Yes I
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, 19
SignaWre of applicant Signature of authorized representative (by executed Power ofAttomey)
ress o plicant Address of authorized representative
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