Age_Fearsd� rt�' i�• AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, couNrv TOWNSHIP rea,a
=6 ,'j; REQUESTING DEDUCTION FROM ASSESSED VALUATION
•t. J Slate Fortn 43708 (R3 / 8-00)
- Prescribetl by the State Board of Tax Commissioners
Imormation contained in this document is CONFIDENTIAL pursuant to IC 6-7.1-12-9. ile a
INSTRUCTIONS FOR FILING: N O V O � ZOO�
To be �led in person or by mail wifh the County Auditor o/ fhe county wheie the property is loca-
ted during the 12 months be(o2 May 11 0l the year the deduction is to 6e effective. .
Deductions lor mobile homes not assessed as real property must file 6etween January 15 a/���
March 31. GIBSON COUNTV .4UDITOR
See
or interest? If owned with someone other than spouse,
indiwte wilh whom
on cont2ct atleast one (1) yeah
/ Legal description
�Yes ❑ No
s the applicant 65 years of age or more on Dece ber 31 of the year
r to the current yean
�Yes ❑ No
ilipnPs date of birth (monfh, day, year)
ed by a surviving, unmarried spouse, what was the spouse's age at
time of death?
you filetl for any
you filed for deduGions in any other
❑ Yes No
❑ Yes ❑ No
Record number
Assessed value of the property as of March 1, wrtent year (may not
exceed 869,000J
Does the combined annual adjusted gross income of the applicant and any
individuals sharing ownership exceed $25,000?
❑ Yes ❑ No
$
I/We ceAify under penalty of perjury �that the above and foregoing information is true and corred and that the applicant was a resi-'