HomeMy WebLinkAboutAge_Whittend,�"'^o� 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
mustfile between January 15 and March 31. See reverse foradditional instructions
County � Township� Year
����
�;` j • ,r b
MAR 2 � 1��.:
and qualifications. �� � ly,, ,_,,
,���
1
Ap icant wner or c ntract er) � �(`` ��
�.. ��,
Is ap li ant the sole leg o If no, what i his/her exact share or If owned with someone other than
equit e owner? es O no interest? spouse, indicate 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
� District Key Number/Legal Description Record No.
� �l - 3 Q�O ' 0(7 � Page No.
Is the reai property used a�n '°ccupi primarily Assessed value of the property as of March 1, current
for his/her residence? 9'yes ❑ no year (may not exceed $19,000).
Was the applicant 65 years of age or more on ApplicanYs date of birth ""
Dece er 31 of the year prior to the current year? °� ��
es 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 ce of income Amount of income
income of the applicant and any individuals � � p�
sharing owner� ip exceed $15,000?
� yes �9�fio
Total ' (..��`�, O 0
Have you filed for any other deductions? If yes,, �wnhat de uctions? i
�'l �
Have you filed for any deductions i� 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-
cani was a resident of Indiana and owner of the aforementioned property on March 1, 19��
�rja Authorized Representative (by executed Power of Attorney)
(�
-��
Address Appli ant ,. _ Address of Representative .�
�� a s. PR,���
.,
� R��cC-ro -� 47�7a