HomeMy WebLinkAboutAge_Walker (3)n.
� AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, cour+rr TOWNSHIP YEAR
REQUESTING DEDUCTION FROM ASSESSED VALUATION
� � Stata Fwm 43708 (R5 / 6-03)
�a•
Prescribed by Ne Department ot Loral Govemment Finance
Int�tion contained in this document is CONFIDENTIAL pursuant to IC-,�6-1!1-02-9 � File Mark
Il �
UCTIONS: 11 � � FILING DATES:
To be filed in person or by mail with the County Auddor of the counry where ,- 20Q�) Real property: During the 12 months before May
the property is located. NO� 0� 11 of the year the deduction is to be eHective.
^ /� 2) Mobi�� homes assessed under I.C.6-1-1-7;
See reverse side (or additional insGuction and qualifications. �/ �_�%�.�,,.,.behveen January 15 and Maroh 31 0/ the year
R.r.�n�✓'`!I_...(T� cn�ithe;deductionistobeeflective.
/d GIBSON cv�,-. . .
Name of appliw wne� or contract buyer)
N �(iA��`�'�_�
Is aooliwnt ihe s legal or eQUiWble owne�t ' If No, what is hisRier exact share or interest? If owned with someone other Nan spouse,
indicate vrith whom
�Yes ❑No
If name on record is different than that of applicant, indicate below
Name ot contract seller (applicant must have 6een buying on contract at least one (1J yea�)
Address of conVact seller Is the property in questlon:
❑ Real property ❑ Mobile home (I.C. 6-7-7-�
Taui istnct � Key number / Legal descnption Record number Page number
�; - =p=30_6_D.��
��e property used and occupied p�marity for / Assessed value ot the pmperty as of March 1, curtent year (may not
er residence? � exceed $144,000J
[1�'4es ❑ o
Was the applicant 65 years of age or more on December 31 ot e year poes the combined annual adjusted gross income of the applicant and any
prior to the currenl year7 individuals sharing ownership exceed 525,000?
❑ es ❑ No ❑ Yes ❑ No
Applicani's date of birth (month, day, year) ,
$ �
Have you filed for any oiher deductions? If Yes, what deducUons?
❑Yes ❑No
Have you filed tor deduciions in any oiher county7 If Yes, what county?
ov� allo
IM/e certify under penalty of perjury tha[ the above and foregoing information is true and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
Signature of applicant Signature of auNorized representative /by axecuted Power olAttomey)
dr of applicant � Address of authorized representative
I �I