HomeMy WebLinkAboutAge_Ashyv_R,• � AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, courm TOWNSHIP veaR
REQUESTING DEDUCTION FROM ASSESSED VALUATION
S l Stata Fortn 43708 (R614-Oa) - '
• Preunbed by ihe Depanment of Local Gwemment Finance
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�rmation contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12•9 and IC 6-1.1-359� g g ��
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INSTRUCTIONS: FILI DAi'�S�"�
To be filed in person or by mail with the County Auditor of the county where 1) Real propg(ty:�uPn�e,12 months before May
the property is located. 11 0( the��� ekl ion is to be eHective.
2) Mobile homes assessed underl.C.6-1-1-7;
See �everse side lor additional instruction and qualifications. behveen�y� March 31 of the year
the deduction to be ective.
GIBSON COUNTY AUDITOR
Name of applicant (owner or
or
�,Yes ❑ No �
If name on record is diRerent than that of applicant, indicate beiow
wnVact
disirict
Was the appliwnt 65 years ot age or more on
prior to the curtent year7
Applicanl's date of birth (monfh, day, year)
If filetl by a surviving, i
fhe time of deathY
Have you filed (or any
Have you filed for ded
$
INVe certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant was a resident
of Indiana and owner of the a(orementioned property on March 7, 20 _
: of appliwnt
v�
of applicant
/!Y � �
representative
olAttomeyJ