Age_Ready�n
� AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, couNrr TOWNSHIP venR
- REQUESTING DEDUCTION FROM ASSESSED VALUATION
� ,�� � Stata Fortn 43708 (RS / 6-03)
Prescnbed Dy Ne Department af Loral Govemment Finance
Intortnation contained in this document is CONFIDENTIAL pursuant to IC E1.1-12-9. le M
�TRUCTIONS: FILING DATES.� � �
To 6e �led in person or by mail with tAe Counry Auditor o/ the county where 1) Real property: Durjqg �e�2,�no,�th�s be%�e May
fhe property is located. 11 of [he year the t1�d ct r�(ls !81 e8ective.
2) Mobile homes assessed under�l.C.6-1-1-7;
See reverse side for additional instruc[ion and qualifications. between Jenuary 15= 'Ma� 31 o/,the year
the deduc�oriis-to.be.e6ectire.c�. �,� U
Name of
or
name on
❑ Yes ❑ No
GIBSOiJ C'OUN i Y
or interesY? If ownetl vnN someone other than spouse,
indicate vrith whom
of conVaa seller (applicant must have been buying on contract af least one (1) }rear)
of conVact seller
property use
r residence?
Ne applipnt 65 years ot age or more on
ro the cuvent year?
Appliwnt's
If filed by a surviving, unmarried spouse,
Ihe tlme of death?
Have you filed tor any
you filed for deductions in any
❑ No
he year
Yes ❑ No
was the spouse's age at
❑ Yes ❑ No
Is ihe praperty in questian:
❑ Real property ❑ Mobile home (I.C. 6-1-7-n
Kssessetl value ot Ne property as oi MafCtl 7, cur
exceed 5144,000)
Does the combined annual adjusted gross income
individuals sharing ownership exceed 525,000?
Source of Income
�
$
deducGons?
year
any
❑ Yes ❑ No
Amount of Ineome
TOTAL I � �
L
❑ Yes ❑ No �
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that Ihe applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _.
3nature of applicani �1 Signature of authorized representative (by executed Power olAttomey)
��
�
Address of authorized