HomeMy WebLinkAboutAge_Sullivan�" AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, CoUNTV 70wri5HIP YEnR
- � REQUESTING DEDUCTION FROM ASSESSED VALUATION
•,` State Form 43708 (R3 / &00) � ',�i
'•'• � PresrfibeA Dy fhe S�ale Board of Tax Commi55ioners . G��
In ormation contained in this document is CONFIDEN7IAL pursuant to IC 6-1.1-12-9. ����FileyNl`a�rk
INSTRUCTIONS FOR FILING:
To be filed in person or by mail with the County Auditor o/ the county where the property is loca-
ted during the 12 months before May 11 01 the year the deduction is to be e/fective.
Deductions for mobile homes not assessed as real property must file between January 15 and
March 31. - -
See reverse side /or additional instruc6on and qualifica6ons.
or
name on
con6act bu}rer)
_ �
❑ Yes ❑ No
or
Name oi conVact seller (applicant must have been buying on contrsct at least one (1) yearJ
Is the real property used and occupied
primariy for hisTher residence?
Was tne applicant 65 years or age or more on
prior to fhe current yea(7 �
Ly7Yes ❑ No
mber 37 of the year
L�Yes ❑ No
filed by a surviving, unmarried spouse, what was the spouse's age at
e time of death?
you
you
ror any omer aeauwons r
❑ Yes ❑ No
for dedudions in any other wunty7
� Yes ❑ No
I/We certify under penalty of perjury that the above and foregoin
denl of Indiana and owner of the aforementioned property on M:
sgnamre or appnwnc
JUL � 1 2031
. �ia/.�N7„ .7�?0�
I with someone other than spouse,
with whom
Record number
i�Ne property as of March
Uoes tlie comDlneO annual atl]usted gross incor
individuals sharing ownership exceed 525,0001
��V �
Page number
year
applicant and any
o��-��.��a-oc�
0 (�-�L. (� S -5�.,���� .