Age_Hacker (3)•,\0
• `< AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
'� ° REQUESTING DEDUCTION FROM ASSESSED VALUATION
�'�i ��• Stata Fortn 43708 (R6 / 4-Oa)
�'• • Prescribed by ihe Depanment of Lowl Govemment Finance
Information wntained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.7-359.
INSTRUCTIONS:
To be filed in person or 6y mail with the County Auditor oI the county where
the property is located.
See reverse side (or additional instruction and qualifications.
Is appliwnt the sole legal or
name on
>uyerJ /
v�
owner? If No, what is I
❑ Yes C� No
exact share or
Name of wntrad seller (applicant must have been buying on contract at least one (i) year)
s the applicant 65 years ot age or more on
�r to the cuvent year?
�liwnl's
— �
ed by a s�ng, unmamed spouse, what
dme of death?
re you (led for any other deductions7
you
any
,0'Ses � No
�mber 37 0( Ihe year
es ❑ No
/ Ci\ �MJ�
was the spouse's age
❑ Yes
❑ No
COUNTY TOWNSHIP YEAR
File Mark
FILING DATES:
1) Real property: Dunng the 12 months before May
11 0/ the year the deduction is to be eKective.
2) Mo6ile homes ass ed under 1.C.6-1-1-7;
between January 1� f�a� � �
fhe deduction is to ffedtiv
11
APR 2 5 2005
If owned with someone�Jhan�
indicate with whom "V
GIBSON COUNTY AUDITOR
property
p(�y$-0 0 �
Pssessed value of the property as
exceed 5144,000)
property ❑ Mobile home (I.C. 6-7-1-7)
year (may not
combined annual adjusted gross income of the applicant and any
s sharing ownership exceed $25,0007
I/We certify under penalty of perjury that the above and foregoing information is true and correct and lhat the applicant was a resident
of Indiana and owner of the atorementioned property on March 1, 20
.
! � ��
�'
. ,- -
�76 y
representative