HomeMy WebLinkAboutAge_Tyreeej?''o AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
�e = REQUESTING DEDUCTION FROM ASSESSED VALUATION
. :
State form a3708 (R / 9-96)
�";�� l Prescribed by ihe State Board of Tax Commissioners
Information contained in this document is CONFIDENTIAL pursuam to IC 6-1.1-12-9.
INSTRUCTIONS FOR FILING:
To be liled in person or by mail with the County Auditor ol the county where the properry is loca-
ted during the 72 months belore May 11 0/ the year the deduction is to be ellective.
Deductions for mobile homes not assessed as real property must lile beRveen January 75 and
March 37.
See reverse side lor additional inst�uction and qualilications.
Name of applicant (owner or conhacfJxryer) � I �
/ )
applicant the sole Iegai or equitable owner? If No. wha,'is
es ❑ No
name on record is differeni than that of applicant, indicate below
e ot coniract seuer (app�icant must nave i
ess of coniran seller
iq istri
\
� pmperty u ed and occupied primarily fo
er residence?
ihe applicant 65 years of age or more on
to the current year?
��
canfs
any
on
r
exact share
one
COUNTV TOWNSHIP YEAR
r o �
File Mark
7n �����
� 2 � 2��0
-oa 4 ��- o 0
Assessed value ot the property as
exceed $27, 000)
�res ❑No
December 31 of the year
��S
was the spou5e's age at
❑ Yes Lywo
someone otner tnan spouse.
whom
MarCh 7, curren� year (maynot
❑ Yes �
�mbinetl annual atljustetl gross income of the applicant and any .
sharing ownership exceed 520,000?
❑ Yes �
of Income Amount of Income
$ �
� $ �ao
TOTAL I $ / 7 f(1(ii� /��
❑ Yes �No �
IlWe certify under penalty of perjury that the above and foregoing information is irue and correct and that the applicant was a resi-
dent of Indiana and owner of the aforementioned property on March 1, 19 �
�aturey� applicant „ _ SignaNre of authorized representative (by executed Power olAttomey)
v � • w v—�� �
:s of applicant `��� �d IAddress of authorized representative +
%l�iy�
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