HomeMy WebLinkAboutAge_Smith (5)a..•°'A�.� AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
� REQUESTING DEDUCTION FROM ASSESSED
° VALUATION State Form 43708 (1-90) Prescribed by the
° State Board of Tax Commissioners
�
Instructions for filing:
To be filed in person or by mail with the County Auditor of the County where the
property is located during the 12 months before May 11 of the year the deduction
is to be effective. Deductions for mobile homes not assessed as real �rooertv
County
.�
Township� Year
AUG 0 21991
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mus e between January 15 an March 31. See reverse for additional instructions
an qua ifications. � ,�, 11�,_,.-,s
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ppli nt wner or contrac u er),
I applicant the sole leg ct share or If owned with someone other than
eq 'ta le owner? es O no interest? spouse, indicate with whom.
If name on record is different than that of applicant, indicate belo�y-�yo •
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Name of contract seller (Applicant must have been buying on contract at least one (1) year.)
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Address of contract seller
f=r�� F Sm�1-
ing District Key Number/Legal Description Record No.
, �P /9 ==oa_T_5'3� Page No.
Is the real property used an�d cupied primarily Assessed value of the property as of March 1, current
for his/her residence? � yes O no year (may not exceed $19,000).
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Was the applicant 65 years of age or more on Applican�
�"yes ❑ no If filed by a surviving, unmarried spouse, what was the
spouse's age at the time of death?
Does the combined annual adjusted gross Source of income Amount of income
income of the applicant and any individuals (�qbes 9�y� /. �8
sharing ownership exceed $15,000? ��
O yes �o
ENSi o .
Total 9 S /. �7
Have you filed for any other deductions? If yes, what deductions?
Have you filed for any deductions in any other county? If yes, what county?
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the appli-
cant was a resident of Indiana and owner of the aforementioned property on March 1, 19 9� +
Siqnature Authorized Representative (by executed Power of Attorney)
4". .
ddress of Applicant Address of Representative
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