HomeMy WebLinkAboutAge_Williamsej °""o AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
-` ` REQUESTING DEDUCTION FROM ASSESSED VALUATION
�� State Form n3708 (R / 9-96)
"��• Prescribed by the State 8oard of Tax Commissioners
Informaiion coniained in this documeni is CONFIDENTIAL pursuan� to IC 6-t.1-t2-9.
INSTRUCTIONS FOR FILING:
To be liled in person or by mail with the County Auditor o! the counry where the property is loca-
ted dwing the 72 months before May 7 f o1 the year ihe deduction is to be eflective.
Deductions !or mobile homes not assessed as real property must lile beM1veen January 75 and
March 31.
See reverse side lor additional instruction and qualilications.
Name of applicani (owner or cont�act buyer)
il < n QO a in, .h�_ � .�
Is applicant the sole legal or equitable owneR
�'es ❑ No
If name on record is dittereni ihan Ihat of applican
contrad
contract
and occupied
must
If No, what is his/her exaci share of interest?
on
OV�
�es ❑ No
the applicam 65 years of age or more on December 31 of ihe year
to the current year?
etl by a
time of
�e you fi
�e you f�
date of birth (month, day, year)
spouse's age at
any
any other counry?
❑ No
COUNTY TOWNSHIP YEAR
File Mark
�����
APR 0 5 lggg
I with someone other ihan spouse,
with whom
_(e �k - a a � �
Assessed value of the property as of March 7, current year (maynot
exceed 321.000)
❑ Yes L�o
Does the combined annual adjusied gross income of ihe applicant antl any
individuals sharing ownership exceed $20.000?
❑ Yes ❑ No
❑ Yes `�t0o �
I/We certify under penaliy of perjury that ihe above and foregoing information is true and correct and that the applicant was a resi-
dent of Indiana and owner of the aforementioned property on March 7, 19 _ '
Signature of applicani 1 Signature of authorized represeniative (by executed Power o7Attorney)
representative