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AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
REQUESTING DEDUCTION FROM ASSESSED VALUATION
� � 51ate Form 43708 (R7l 5-05)
Presrnbed by the Departmrnl of Local Gavemment FinarKe
Informalion contained in this dowment is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.1-3
INSTRUCTIONS: � - F
COUNTY TOWNSHIP YEAR
File Maric
To be filed in person or by mail with the County Auditor of the county wher Re�l pro� Du 'n th 1 mo hs before June
the property is located. 11 of the year the e u i ' o be eHective.
2) Mobile � sses�{�d,,under I.C.6-1-1-7;
See reverse side for additional instruction and qualifications. \ betwee��rlua�y �5�l�1�Ma�ch 31 0l the year
� the deduction is to 6e effective
If name on
contract
residence?
to Ihe wrrent
If filed by a survivii
the Gme of deaN?
}rou filed for any
- - -- . . `'� 4 '
or equitable R IT No, what is
es ❑No
erri than ihal of applipnt, indipte bdow
must
primarily fw
0
aG-aa�
�
at least one (7) year)
❑Yes ❑No
age w rtrore on December:31 ot Ue year
❑Yes ❑No
nmamed spouse, wh.
you filed for deductions in any
was the spouse's age at
❑Yes
/��
If Yes,
what
(� .Q�a�,
GIBSON COUNTY AUDITOR
If owned vrith someone oNer Nan spouse,
indira�e with wFrom
15 ihe property in question: �
❑ Reai property ❑ Mobile home (I.C. 67-7-7)
the property as of
7, wrrent year
_
❑Yes �JJo I
I/We certify under penalty of perjury that the above and foregoing ink+�**�=t��n is hue and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20
representative (by exewted
�
representative
: �