HomeMy WebLinkAboutAge_Whitlow_^ •� AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, �FeuNTr „ T0 SHIP v�+rt
° ° REQUESTING DEDUCTION FROM ASSESSED VALUATION �� A �
�� .� State Fortn 43708 (R6 / 4-Oa) ' ��
Prescribed by the Depariment of Local Gwemment Finance
� MAK 0 EileZt�ar�lc
'Gformalion wntained in this documeni is CONFIDENTIAL pursuant to IC 6-1.1-72-9 and IC 6-1.1-359.
INSTRUCTIONS: FILING DATES: �a ' ��
To be filed in person or 6y mail with the CountyAuditor of the county where 1) Real prope, � During the 12 months 6efore May
the property is located. 11 0/ the �ye��?h� d��t�ohv�ram� eea�n�e.
2) Mo6ile homes assessed under I.C.6-1-1-7;
See �everse side for additronal instruction and qualifrcations. behveen January 15 and March 31 of the year
the deduction is to be ef/ective.
ame o( applicant (owner or contract t
�
�� applicant the sole legal or quiWble �
� Yes
name on record is diRerent than that
contract seller (appli
of contract seller
�/�/.�—/O/�
exact share or interest?
must have been 6uying on contract a( least one
��9 --oaa��-
property used and occupied primaril�
r residence?
- D d. �
• I�les O No
Ihe applicant 65 years of age or more on Dece ber 31 of the year
to the wrrent yearl
filed by a
e time of
you
you
5 ❑ No
'
the spouse's age a
any oiher deductions?
❑ Yes �o
deductions in any other counry?
If owned with someone
indicate with whom
Is the property in questlon:
spouse,
property ❑ Mobile home (I.C. 6-14-�
description IRecardnumber
Assessed value of Ne property as of March 1,
exceed $144,000)
73qao
Does fhe wmbined annual adjusted gross inc
individuals sharing ownership exceed $25,OOC
If Yes, what deductions?
county?
$
S
TOTAL $
year
of the applicant and any
❑ Yes � No
Amount of Income
❑ Yes �o I
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the applicani was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
Signature ot applicant Signature of authorized representative (by executed Powei ofAttomeyJ
�c .�,��z.� �, �,��; T��
of auNorized representative