HomeMy WebLinkAboutAge_Reede.�.°'° 4 AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
: REQUESTING DEDUCTION FROM ASSESSED
° � � VALUATION State Form 43708 (1-90) Prescribed by the
^• �� State Board of Tax Commissioners
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Instructions 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
mustfilebeiweenJanuary 15and March 31. See reverseforadditional instructions
and qualifications.
Applicant (Owner or contract
Is applicant the sole leg ' If rSo, what is his/her�kact share or If
equitable owner? es ❑ no interest? s
If name on record is different than that of applicant, indicate below:
County Township Year
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DNAY 131996
�UDITOR��
n �iith someone other than
s , ndicate with whom.
Name of contract seller (Applicant must have been buying on contract at least one (1) year.)
Address of contract seller
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Is the real property used and upied primarily
for his/her residence? yes �� no
Was the a icant 65 years of age or more on
Dece er 31 of the year prior to the current year?
ves � no
Does the combined an I adjusted gross
income of the appli nt and any individuals
sharing owner ' exceed $15,000?
O yes o
Have you filed for any other deductions?
Have you filed for any deductions in any other county?
� �
Record No.
Paae No.
Assessed value of the property as of March 1, current
year (may not exceed $19,000).
ApplicanYs date of birth �
If filed by a surviving, unmarried spouse, what was the
spouse's age at the time of death?
Source of income Amount of incomE
Total
If yes, what deductions?
If yes, what 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 1, 19
Signature Authorized Representative (by executed Power of Attorney)
ress of Appiicant Address of Representative �.
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