HomeMy WebLinkAboutAge_Wright (7)d°� �'o AFFIDAVIT OF PERSON� 65 YEARS OF AGE OR MORE, COUr�v TOWNSHIP YEAR
-'` ` REQUESTING DEDUCTION FROM ASSESSED VALUATION
`, • �iE
State Form 43708 (F / 9-96)
��-,y,—;'•" l Prescribetl by the State Boartl of Ta. Commissioners
Information contained in this documeni is CONFIDENTIAL pursuani to IC 6-7.1-72-9.
File Mark
INSTRUCTIONS FOR FILING: r-� � t��1 ���
To be liled in person or by mail with the County Audiror of the county whe�e the property, is loca- �� �� �
ted dwing the 72 months belore May 77 of the year the deduction is to be ef)ective. 't yy �y.y�
Deductions !or mobile homes not assessed as real property must lile beRveen January4S'and
March3l. OC.� :, •�' �gg9
See reverse side for additional instruction and qualilications. �.� � /� �
Name of applicant (owner or confract buyer)
Is applicant ihe sole legal or equitable
If name on record is difterent
Name of contract
contraci
property use
r residence?
�wne . If No, what is his/her exact
❑ No
of applicanL indicate below
mus( have been
ihe applicant 65 years of age or more on
to the current yeaR
on contract ar �easr one
f .•q� - .� , . .
..0
It aWnBtl wllh SOmBOnB Oth@r ihdn SFIOUSB,
indicate with whom
Assessed value of the property as of MarU 7, Curtent year (maynot
exceed 527.000)
❑ Yes ❑ No ❑ Yes o
mber 37 of the year poes the combined annual adjusted gross income of ihe applirant and an
individuals sharing ownership exceed $20.000?
�plicanfs date of
�
filed by a surviving, unmarried spouse. what was the spouse's age ai
e time of death?
you filed for any other deductions?
❑ Yes ❑ No
you filed tor deductions in any other counry?
r�*�
❑ Yes �
Source of Income I Amount of Income
$ai6<<aa
g 763•OU
TOTAL I a
If Yes, what deductions?
Yes, what wunry?
❑ Yes ❑ No �
I/We certify under penalty of perjury that the 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
representative