Age_Brandebourgmq
� AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
�° REQUESTING DEDUCTION FROM ASSESSED VALUATION
�,u� I State Form 43708 (RS / 6O3)
Prescribed by Ne Department of Wral Govemrtrent Finance
I� ation contained in this document is CONFIDENTIAL pursuant to IC E1.7 •12-9.
COUNTY TOWNSHIP YEAR
o ��a,
File Mark
(RUCTIONS: " FILING DATES:
To 6e filed in person or by mail with tAe Counry Auditor o/ lhe counry where 1) Real property: During the 72 months before May
the property is located. 11 of the yea� lhe ded�ction is to 6e eflective.
2) Mobile homes assessed under I.C.6-1-1-7;
See reverse side for additional instruction and qualifications. 6etween January 15 and March 31 of the year
the deduction is to be e8ective.
Name of
or
�Yes ❑ No �
on record is difrerent n that of applicant, indicate below
� �c � ��
oerty used and occupied primarily for
on contract at �east one
❑Yes ❑No
the applicant 65 years of age or more on December 31 of the year
to Ihe current year?
� ❑ Yes ❑ No
�
Have you fiied for any oiher deductions? If Yes, what deductlons7� �� i� '� p
H.•i F
❑ Yes ❑ No g'� J
Have you filed for deductions in any oNer county? If Yes, what counq!� SEP 17 2003
❑ Yes ❑ No /J
I/We certify under penalry of perjury that the above and foregoing information is true and BLttf "tli
of Indiana and owner of the aforementioned property on March 1, 20 _ GIBSON OUN� Y H 0'
applicant - (
l �o,t'S5"� ,�`�i91 o tig /•v
y1��
,�
a resident