HomeMy WebLinkAboutAge_Richardsona°� "'o AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
-'6 ` RE�UESTING DEDUCTION FROM ASSESSED VALUATION
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State Form 43708 (R / 9-96)
�;�"���• Prescribed by the State Boartl of Tav Commissioners
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9.
INSTRUCTIONS FOR FILING:
To be filed in person o� by mail with the County Auditoi of the county where the property is loca-
ted during the 72 months before May 77 0/ the year the deduction is to be el%ctive.
Deductions lor mobile homes not assessed as real property must lile between January 15 and
March 31_
File Mark
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� 2 2 2000
See reverse side for additional instruction and qualilications.
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Name of applicant (owne� or c., er) �).Ci..�i✓v!�^. �
� I � /-� 4'',S T: :��UtiT" nUDITOR
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Is applicant the sole legal or equitable o eR f o, what is his/her exaci share qiintcrest' — If owned wuh someone other than spouse,
�� indicate wiih whom
es ❑ No
If name on record is ditterent than that of applicanL indicate below
Name of contract seller (applicant must have been buying on contract at leasf one (7 J yea�J
Address of coniraci seller
g rict . Key number / Legal description Record number Page number
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Is the propeny used and occupied primarily for Assessed value of the property as of March 1, current year (may not
his/her residence? exceed $27,000)
Yes ❑ No ❑ Yes o
Was the applicani 65 years of age r more on December 37 of the year poes the combined annual adjusted gross income of the applicant and any
prior to ihe current yeaR individuals sharing ownership exceed $20,000?
❑ Yes ❑ No
ApplicanYs
$
Have you filed for any other deductions? II Yes. what deductions?
�Ll
Yes ❑ No �v
Have you filed for deductions in any oiher counry? I} Yes. what county?
❑ Yes o 1
IlWe certify under penalty of perjury that the above and foregoing information is true and correct and that the appli:,ant was a resi-
dent of Indiana and owner of the aforementioned property on March 1, 19 _ _
Signature of applicant Signature of authorized representative (by executed Power olAnorney)
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�dress of applicant Address oi authorized representative
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