HomeMy WebLinkAboutAge_Montgomery (3)� e•°'"a AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
-° � REQUESTING DEDUCTION FROM ASSESSED
t � VALUATION State Form 43708 (1-90) Prescribed by the
In�^• �� State Board of Tax Commissioners
uctions 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
mustfile betweenJanuary 15and March 31. See reverseforadditional instructions
and qualifications.
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UD TO- �R-� �
Applica t(Owner or contract buyer) �
4 e-�r-eh� `�"h ��
Is applicant the sole legal or If n, what is his/h r exact share or If owned with someone other than
equitable owner? � yes O no interest? spouse, indicate with whom.
If name on record is different than that of applicant, indicate below:
� d'IJLT�-S `f' --
Name of contract seller (Applicant mu have been buying on cb tract at least ne (1) year.) , ,;,
Address of contract seller
T-�ing District Key Number/Legal Descripti n ,I Record No.
. t�l - C� ��o -OU N Page No.
Is the real property used and occupiedT pnmari� Assesse alue of the property as of March 1, current
for his/her residence? �yes O no year (may not exceed $19, 00).
� S � o - �3� v
Was the applicant 65 years of age or more on ApplicanYs date of birth �_ _��
De� �mber 31 of the year prior to the current year? �
�,yes ❑ no If filed by a surviving, unmarried spouse, what was the
I spouse's age at the time of death?
Does the combined annual adjusted gross
Have you filed for any other deductions? If yes, what ded ctions?
Have you filed for any ded t ns in any other county? � If'yes, wfiat county? ' ��'�'-
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't�,%I S� �
� nature Authorized Representative (by executed Power of Attorney)
� .
ress of Applicant Address of Representative �.
.
k �, .