Age_Hoeflingd`'j"'"a AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
-a � REQUESTING DEDUCTION FROM ASSESSED VALUATION
�• SWteForma3708�R/9-96)
��' Prescribed by Ihe State Board ot Tas Commissioners
Information contained in this document is CONFIDENTIAL pursuant to IC 6-7.1-12-9.
�- INSTRUCTIONS FOR FILING:
To be liled in pe�son or by mail with the County Auditor of the county where the property is loca-
ted during the 72 months before May 7 7 0/ the year the deduction is to be elfective.
Deductions lor mobile homes not assessed as real property must lile between January 75 and
March 37.
See reverse side (or additional instruction and qualifications.
of applicant (owne� or contract
applicant the sole legal or
name on record is diHeren
ame of contraci seller (apF
idress of contraci seller
, �\.J�-C.JV
Is ihe property used and occupiec
hisiher residence?
is
'S'es ❑ No I
ihat of applicant, indicate below
Was the applicant 65 years of age or more on
prior ro ihe current year?
been
0
5hare ofinterest?
on conrract af least one �7) year)
COUNTV TOWNSHIP YEAR
File Mark
�� � d � ;��
APR 19 1999
GiBSON
with someone other than spouse,
with whom
Assessetl value of the property as oi Mamh 7, wrrent year (may not
exceed $21.000)
❑ Yes ❑ No ❑ Yes ❑ No
mber 37 of the year poes the combined annual adjusied gross income ot ihe applicant and any
individuals sharing ownership exceetl $20.000?
ApplicanYs
—����
If filed by a surviving, unmarried spouse, what was the spouse's age at
the time of death?
you filed for any other deductions?
❑ Yes ❑ No
you filed for deduciions in any other wunty?
❑ Yes ❑ No
❑ Yes ❑ No �
I/We certify under penalty of perjury that the above and foregoing information is irue and correct and that the applicant was a resi- -
dent of Indiana and owner of the aforementioned property on March 7, 19
�— `� IAddress of authorized representative
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olAttomey)
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