HomeMy WebLinkAboutAge_Spindler°"—'o AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
ei � RE�UESTING DEDUCTION FROM ASSESSED VALUATION
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��Siate Form 43708 (R / 9-96�
Prescnbed Dy Ne SWte Boartl of Tas Commissioners
Information contained in this document is CONFIDENTIAL pursuani to IC 6-1.7-12-9.
INSTRUCTIONS FOR FILING:
To be liled in person oi by mail wiih the Counry Auditor of the county where the property is loca-
ted during the 72 months belore May 77 0/ the year the deduction is to be eIlective.
Deductions !or mobile homes not assessed as real property must lile bertveen January 75 and
AAnmh 41
COU V TOWNSHIP YEAR
C
File Mark
.���.i_�!�:� .
MAR 2 2 2���
See reverse side for additional instruction and qualilications.
Name of applicant (owner or contract 6vye�J GIBSON „OU TY AUDITOR
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Is applicani e sole legal or equi[able o n? If No. what is his/her e:act share of interest? If owned with someone other than spouse,
indicate wiih whom
�i'es ❑ No
If name on record is diNerent than that of applicant, indirate below
Name of contract seller (applicanf must have been buying on contract at least one (1 J year)
Address ot contract seiler
ing districi Key number / Legal description Record number Page number
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Is the property used and occupied primarily Por Assessed value of the property as of March 1, current year (maynot
hisfier residence? exceed $27,000)
❑ Yes ❑ No ❑ Yes ❑ No
Was the applicant 65 years of age or more on December 31 of ihe year
$
Have you filed for any other deductions? If Yes, what deductions? •
`S'Yes ❑ No
Have you filed for deductions in any other county? If Yes. what counry?
❑ Yes LfPlQ
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant was a resi-
dent of Indiana and owner of the aforementioned property on March 1, 79 _
ISignature of ap/p�licant SignaWre of auihorized represemative (by ezecuted Powei o1 Attomey)
fYY�/�- 1 . c
.,ddr of applicant IAddress of authorized representative
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