HomeMy WebLinkAboutAge_Robling'°`�0 AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
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S�{e Fortn 43708 (R2112-99)
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Presaibed by �he State Board ol Tax Commissioners
Informalion contained in this document is CONFIDENTIAL pursuant to IC &1.1-72-9.
INSTRUCTIONS FOR FILING:
COUNTY TOWNSHIP YEAR
File Mark
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To be filed in person or by mail wilh the County Auditor of the county where the property is loca-
ted during the 12 months before May 11 of the year the deduction is to be effective. � � � r ��Lt�
Deductions for mobile homes not assessed as real property must file between January 15 and
March 31. r/� ,�� �
See reverse side for additional instruction and quali�cations. ,i`�.,t�u.���L..�,:�'�"`T,"-`�(
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Name of ppli (owner or contr t b yer
Is applicant the sol egal or equitable ner? If No, what is his/her exact share or interest? If owned wilh someone other than spouse,
indicate wilh whom
Yes ❑ No
If name on record i diHerent than that of appliwnt, indicale below
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Name of conlr�ct Iler (applicanl must have been buying on contract at least one (1) year)
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Address of co raC seiler
�zing ' r Key number I Legal description Record number Page number
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Is t real property used an occupied Assessed value of lhe property as of March 7, current year (may not
primarity for hisRier residence? exceed 523,000) .
es ❑ No
Was the applicant 65 years of age or more on December 37 of [he year poes the combined annual adjusted gross income of the applicant and any
prior to the current year? individuals sharing ownership exceed 325,0001
es ❑ No ❑ Yes ❑ No
Applicant's date of birth (month, day, year) Source of Income Amount o( Income
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— �—
If filed by a surv'rving, vnmarri s age at 5 '
the time of death?
TOTAL $
Have you filed for any other deductions? If Yes, what deductions? �
❑ Yes U�7o
Have�you fled for deductions in any other county? If Yes, what wunty? -
❑ Yes
INVe certify under penalty of perjury lhat the above and foregoing information is true and correct and that the applicant was a resi-
dent of Indiana and owner of the aforementioned property on March 1, 20 _
Signature of applicant Signature of authorized representalive (by ezecuted Power of Attomey)
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. ress of ap icant � Address of authorized representative 4?
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