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ej °'"a AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
� = RE�UESTING DEDUCTION FROM ASSESSED VALUATION
�+d�• Stare Form a3708 (R / 9-96)
"�, PreSCribed by Ihe State Board of Tax Commissioners
Courirv
g� � ��� File Mark
Information coniained in ihis document is CONFIDENTIAL pursuant to IC 6-1.7-12-9. ��9
INSTRUCTIONS FOR FILING: l�
To be filed in person or by mail with the County Audito� ol the county where the propEy(y iSJpr�aj999
ted during the 72 months be)ore May i t ol the year the deduction is to be ellectiveN� R V!
Deductions !or mobile homes not assessed as real property must lile behveen nuary 75 a d
March 31.
See reverse side lor additional instruction and qualifications. GIBSON COU TY AUDITOR
(owner or contract 6uye�J �
Is applicani ihe sole legal or equitable owner?
❑ Yes ❑ No I
It name on record is dittereni ihan that of applicant, indicate below
share ofinterest?
Name of contract seller (applicant mus( have been buying on contracf af least one (7)
of contraa
property use
r residence?
'as the applicani 65 years ot age or more on Deci
ior to the current yeaR
�plicaM'
filed by a surviving, un � arried spouse, what was
e time of death?
you filed for any oiher deductions?
you filed for detluctions in any other county?
❑Yes ❑No
mber 37 of the year
spouse's age at
❑ Yes ❑ No
❑ Yes ❑ No
It OwflOtl Wlth 5ome0n0
indicate with whom
YEAR
spouse.
A55e55etl value o� thB property as of MarU t, turrent year (may not
exceed 527, 000)
❑Yes CEj�iGo
�mbined annual adjusied gross income of the applicant and any
sharing ownership exceed 520,000?
Souree of Income
Yes, what deductions?
Yes. whai counry?
❑ Yes ❑ No
Amounloflncome
$ g yas-
$ �9 a
TOTAL � $ ��
I/We certify under penalty of perjury that ihe above and toregoing information is true and correct and that the applicant was a resi-
dent of Indiana and owner of the aforementioned property on March t, 19