HomeMy WebLinkAboutAge_Smith (4)rt�< AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, courm TOWNSHIP venrt
'� � � REQUESTING DEDUCTION FROM ASSESSED VALUATION
�' i State Fortn 43708 (R6 / 4-0a)
Presaibed by the Department of Local Govemment Finance
I�rtnation contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.1-359.
INSTRUCTIONS: FILING DATES: MAY 1 U�IIJ�O
To be filed in person or by mail with the County Auditor of the county where 1) Rea/ property: During the 12 months 6efore May
the property is located. 11 of the year the ,�ep;6e eHective.
2) Mobile homes assesse nder l�6-i-1-7;
See reverse side for additional instruction and qualifications. � be�+'ee��ii�Ah�r�h��4i�4N� year
�, n the ded on is o e ective.
n JI l�n �CQa
N� pt applicant wneroi
/�
Is applicant the sole legal or
If name on record is diRerert
Name of wntract seller (app
s
hisRier residence?
conNact buyer)
:quitable ovmeR If No, what is his/her exact share or
Q Yes ❑ No
than that af applicant, indicate below
icant must have been bwina on contract at least one (71 ve
for
Was the applirant 65 years of age or more on
prior to the current year7
If filed by a surviving,
the Ome of death?
you
you
any other deduc6ons7
vnih someone other tnan spouse,
with whom
Is the praperty in question:
❑ Real property ❑ Mobile home (I.C. 6-1-7-�
Key number / Legal description Record number Page number
�/�r'- Oa 3 �4- �o
Assessed value of the property as of March 1, wrrent year (may not
exceed 5744,000)
❑ Yes ❑ No
mber 37 of the year poes the combined annual adjusted gross income o( the applicant and any
individuals sharing ovmership exceed $25,000?
❑ Yes ❑ No
was the spouse's age a
❑ Yes ❑ No
in any other county?
❑ Yes ❑ No
❑ Yes O No �
I/We certify under penalty of perjury that the above and foregoing information is true and correcl and that lhe applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
applicant
�
�-te�.^i� .'�-�el�.-ttn-�3—�
representative