HomeMy WebLinkAboutAge_Jennings�_R•n 4 AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
` REQUESTING DEDUCTION FROM ASSESSED VALUATION
�° � Stata Fortn 43708 (R6 / 4-04) �
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Prescribed by lhe DepatlmeM ol Local Govemment finance
�rmation wntained in this document is CONFIDENTIAI pursuant to IC 6•7.1-12-9 and IC 6-�.1-35-9.
INSTRUCTIONS:
To be filed in person or by mail with the CountyAuditor of the county where
the property is located.
See �everse side !or additional instniction and qualifications.
COUNTY TOWNSHIP YEAR
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� Fi e rk
FILINGDATES�UN 0 6 ZOO6
1) Real prope . During the 12 months belore May
11 0/ the year the deduction is to 6e eRecfive.
2) Mobile horr! �� ��
srassesse6�fimder I.C.6-i-iJ;
thed�%�JC�it %�����dA�����1 o/theyear
o e effec �ve.
Name of applic t(owner o� contrac uyer) �
Is applicant the ole legal or equita ovm Ii No, what his/her exact share or Interest? If ow�ed with someone other than spouse,
indicate w(th whom
es ❑ No
If name on record is diRerent than that of applirant, indicate below
Name of wntract seller (applicant must Aave been buying on canfract af least one (i) year)
Address o( convact seller Is the property in question:
❑ Real property ❑ Mobile home (I.C. 6-7-7-7)
Taxing 'strict Key number / Legal descnption Record number Page number
� �n 01 - �I 35 g -tX�
Is the property used and occupied primarity for Assessed value of ihe property as of March 7, current year (may not
hisRier residence? exceed 5744,000J
❑Yes ❑No
Was the applicant 65 years of age or more on December 37 fhe year poes the combined annual adjusted gross inwme of the applicant and any
priw to the wrrenl yearl individuals sharing ovmership exceed 525,0007
Yes ❑ No ❑ Yes ❑ No
ApplicanPs
what was the spouse's age at $
the tlme of death?
TOTAL 3
Have you filed for any other deductions7 If Yes, what deductions?
❑ Yes ❑ No
Have you filed for deducUons in any other county? If Yes, what wuntyt
❑ Yes ❑ No
I/We certify under penalty of perjury that the above and foregoing information is lrue and correct and ihat the appiicant was a resident I
of Indiana and owner of the aforementioned property on March t, 20
ig tur appiicant ISignatureo(authorizedrepresentative(byexecufedPowerolAtfomeyJ
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re of applicant Address of authorized representative
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