HomeMy WebLinkAboutAge_Williams (6)'rt�; AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, courm TOWNSHIP renrt
` REQUESTING DEDUCTION FROM ASSESSED VALUATION
�> � Stata Form 43708 (R614-0a)
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Prescribed by Ihe Depariment of local Govemment Finance
Information contained in ihis document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-7.135-9. ����F p A�
INSTRUCTIONS: FILIN DA S: ��
To 6e filed in person or by mai! with the CountyAuditor of the county where 1) Real property: Dunng the 12 months 6efore May
the propeRy is /ocated. 11 of the�� the ��i(}�n is to be eNective.
2) Mobile homes assessed under 1.C.6-1-1-7;
See reverse side for additlonal instruction and qualifications. betweer� January��March 31 of the year
� the dedu�d�is�t ctive.
Is appliwnt the sole legal br equitable owneR If No, what i h� is/j/er exact share or interest?
\J
Q Yes ❑ No
I( name on record is diKerent ihan that of applicant, indicate below
Name of wntract seller (applicant must have been buying on contract at least one (7) year)
Address of wntrad seller
�9P���
Is the property�d occupied primarily fo
hisAier residence? .
Was the applicant 65 years of age or more on
prior to the current year?
AppliwnCS date of birth (month, day, year)
Have you filed for any other deductions?
Have you filed for deduUions in any olher counry?
❑ Yes ❑ No
❑ Yes ❑ No
i someone other ihan spouse,
whom
❑ Real property ❑ Mobile home (I.C. El-7-n
as of March 7, current year (may not
5144,000)
e combined annual adjusted gross income
als sharing ownership exceed $25,0001
UWe certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant was a resident
of Indiapa and owner of the aforementioned property on March 1. 20 _
\
applicant
of aulhorized representative (by executed Power olAttomey)