HomeMy WebLinkAboutAge_Kays�" AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE� couN7v TOWNSHIP vEnR
4 REQUESTING DEDUCTION FROM ASSESSED VALUATION
S f State Form 43708 (R3 /&00) /
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Presaibed by ihe State Board of T� Commissioners - F�
I ormation conWined in this document is CONFIDENTIAL pursuant to IC fr7.7-72-9. ���Fil�
INSTRUCTIONS FOR FILING:
To be filed in person or by mail with the County Auditor o( the county where fhe property is loca-
ted dunng the 12 months belore May 11 of the year the deduction is to 6e ef/ective.
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GIBSOP! COUN7Y AUDiTOR
MAY 0 8 2003
Deductions (or mo6ile homes not assessed as real property must (le belween January 15 and
March 31.
See reverse side for additional instruc6on and qualifica6ons.
Name of applicant (owneror conhact buyer)
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Is applicant the sole legal g�,�quitabte ownen If No, what is hislher exaC share o terest? If owned with someone other than spouse,
/� indirate with whom
❑ Yes ❑ No
I( name on record is dfierent than that of appliwnt, indipte below
Name of conVact selier (applicant must have been buying on contract at least one (1) yea�
Address of contrad seiler
, T�axing disVid Key number / Legal description Record number Page number
, � �3=-�.1:0-�=3=oa
Is the real property used and occupied Assessed value of the property as of March 1, current year (may not
primariy tor hislher residence? exceed 369,000)
❑ Yes ❑ No
Was the applicant 65 years of age or more on December 31 of the year poes the combined annual adjusted gross income of the applicant and any
prior to the wrrent yeaR �/ / individuals sharing ownership exceed $25,000? ��
l�Yes ❑ No ❑ Yes L?No
ApplipnPs date of birth (month, day, yearJ
$
Have you filed (or any other deductions7 If Yes, what deduUions?
❑ Yes ❑ No
Have you filed for dedudions in any other county? I( Yes, what county?
❑Yes ❑No
I/We certify under penalty of perjury that the above and foregoing information is true and correc[ and that the applicant was a resi-
dent of Indiana and owner of the aforementioned propeAy on March 1, 20 _
S' ature ot appliwnt Signature of auNorized representative @y exewted Power ofAttomey)
Jress piipnt Address of authorized representative
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