HomeMy WebLinkAboutAge_Lawson_° �,�.•,a4 AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
' REQUESTING DEDUCTION FROM ASSESSED VALUATION
�O , SWte Fortn 43708 (R614-Oa) �
iu.
�� Prascnbed by ihe Depanment of Lowl Gwemment Finance
rmaGon wntained in this document is CONFIDENTIAL pursuant to IC 6-1.1-72-9 and IC 6-1.1-359.
COUNTY TOWNSHIP YEAR
File Mark
INSTRUCTIONS: FILING DATES:
To 6e filed in person or by mail with the County Auditor o/ the county where 1) Real property: During the 12 months before May
the propeRy is located. 11 / th h d d
See reverse side (or additional instruction and qualifications.
Name of applicant (owner
or
❑ Yes ❑ No �
name on record is diRerent fhan that of aOPlicant, indicate
must
on conUact af
i �
,�-'
exact share or
o e year t e e uc6on is to be eKechve.
2) Mobile iromes assessed under 1.C.6-1-1-7;
between January 15 and March 31 ot the year
the deduction is to be effective.
with wmeone other than spouse,
with whom
Address ot conUact seller Is fhe prope question: Q� �"�
GIBSON COUNTY AUDITOR
Real property ❑ Mobile home (I.C. 6-1-7-�
Tax d� Key number I Legal description Record number Page number
� ��d2'��/79'Oa
Is Ne property used and occupied p arily for Assessed value of the property as of MarcFi 1, current year (may nof
hismerresidence? / exceedS144,000) . .
�d� ❑ No
Was the applicant 65 years of age or more on December 37 of year poes the combined annual adjusted gross inwme of the appiicant and any
pria to the current year7 � individuals sharing ownership exceed 525,0007
�'
Appliwnfs date
Have you filed (or any other deduMions?
O Yes ❑ No
Have you filed for deductions in any other county?
Yes.
9
�.
❑Yes /PINo �
IANe 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 aforementioned propeRy on March t, 20 _
�nature of applicant � Signamre of authorized representative (by executed Powe� o7Attomey)
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