HomeMy WebLinkAboutAge_Weist.�- ..
d.�•"•°v� 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 property
mustfite betweenJanuary 15and March 31. See reverseforadditional instructions
and qualifications.
County Township Year
File Mark
�' ;' >
2
Applicant ( wner or contra�buyer) � ' �A J
�
Is applicant the sole I I or If rr�fis fiis/her exact share or If ow � Qfd other than
equitable owner? �s O no intere^� spouse, in ate with whom.
If name on record is different than that of applicant, indicate below:
Name of contract seller (Applicant must have been buying on contract at least one (1) year.)
Address of contract seller
T^xi istrict Key Number/Legal Description Record No.
��� � —O3 3'QCi PageNo.
Is the real property used and occupied prim—an'f� Assessed value of the property as of March 1, current
for his/her residence? ❑ yes ❑ no year (may not exceed $19,000).
Was the applicant 65 years of age or more on ApplicanYs date of birth — —
December 31 of the year prior to the current year?
O yes O 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 S
sharing owner ip exceed $15,000?
❑ yes � o
Total
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?
IlWe 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
Siqnature Authorized Representative (by executed Power of Attorney)
///� I .
r /�/ �/°'l '" x�.�+-/ - ♦
�_:
Addres of Applicant Address of Representative �