HomeMy WebLinkAboutAge_Payton� �'" � AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
�� REQUESTING DEDUCTION FROM ASSESSED VALUATION
�` Slale Form 43708 (R3l 8-00)
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PresuibeA by ihe Siate BoarA of Tax Commissioners
I�ation contained in this dowment is CONFIDENTIAL pursuant to IC G7.1-12-9.
INSTRUCTIONS FOR FILING:
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MAR 3 0 2001
To be filed in person or�by mail with the County Auditor o( the county whe2 the property is loca-
ted during the 12 montlis be(ore May 11 0/ the year the deduction is to be elfective.
Deductions for mo6ile homes not assessed as 2a1 property must fi/e between January 15 and GIBSON COUNTY AUDITOR
March 31.
See reverse side for additional instruction and qualifications.
Name of appii ant (ownerorcontract buyer)
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Is appliwnt the sole Iegat or equitable owneR If what is hisRier exact share or interest? If owned wilh someone other than spouse,
indiwte with whom
� ❑ No
If name on rewrd is difterent than that af applicant, indicate below
Name of contrad seller (epplicant must have been buying on contract at least one (1J yearJ �
Address of contrad seller . . .
Tazing distrid Key number / Legal desctiption Record number Page number
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Is the real property used and occupied Assessed value of the property as of March 7, cunent year (may not
primariy for hisTher residence? exceed 569,000)
es � No .
Was the appliwnt 65 years of age or more on December 3 f the year poes the combined annual adjusted gross income of the applicant and any
prior to the current yea(7 individuals sharing ownership ezceed $25,000?
es ❑ No ❑ Yes � No
ApplicanPs date of birth (month, day, yeah •
$
Have you filed for any other dedudions7 If Yes, what deductions?
• ❑Yes ❑No
Have you filed for dedudions in any other county? If Yes, what couny?
❑ Yes ❑ No
I/We certiy 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 lhe aforemenlioned property on March 1, 20 _
Signature of applicant . Signature of authorized representalive (by executed Power olAttomey)
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ess of applicant Address of authorized representative R y;
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