HomeMy WebLinkAboutAge_Lagneau..•°'°o AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
.°�_• � REQUESTING DEDUCTION FROM ASSESSED
= VALUATION State Form 43708 (1-90) Prescribed by thQ
�' �•�• � State Board of Tax Commissioners �tr�
In�ctions for filing:
To be filed in person or by mail with the County Auditor of the County where the
property is located during the 12 months before May 11 of the year the deduction
is to be effective. Deductions for mobile homes not assessed as real property
must file between January 15 and March 31. See reverse for additional instructions
and qualifications.
Applicant
buyer)
Is applicant the sole le If no, what is his/her exact share or
equitable owner? yes O no interest?
If name on record is different than that of applicant, indicate below:
Name of contract seller (Applicant must have been buvinp on contract at
Address of contract seller
T i �i Key Number/Legal Descr
�`- 0�9-Ois37-
I�ne real property used and pied primarily
for his/her residence? yes O no
Was the ap licant 65 years of age or more on
Dece r 31 of the year prior to the current year?
r yes O no
Does the combined annual adjusted gross
income of the appli nt and any individuals
sharing owner p exceed $15,000?
O yes no
Have you filed for any other deductions?
Have you filed for any deductions in any other county?
County Township Year
r ��
� �I�� �
APR 2 6 1993
.. �,+�,� �' � �'s
'If owned witti someod� other than
spouse, indicate with whom.
one (1) year
� Page No.
Assessed value of the property as of March 1, current
year (may not exceed $19,000).
.
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
Signature _ Authorized Representative (by executed Power of Attorney)
Address of
a s .v, nr/�f .
Address of Representative