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AFFIDAVIT OF PERSON, 65 YE���'OF AGE OR MORE, cour+TV TOWNSHIP v�
REQUESTING DEDUCTION FROM ASSESSED VALUATION
/ Spte Form 43708 (R7 / 506)
� I~ Pi¢smbed by the Oepartment of Lacal Govemment Fvwwz
Infortnalion contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.7-35-9. �����
INSTRUCTIONS: FILING D S.
To 6e filed in person o� 6y mail with the Counry Auditor of the county where 1) Real property: During the 12 months before June
the property is located. 11 0/ the yeaQ�d�ic�h�BQp'to 6e effective.
2) Mobile homes assessed under I.C.6-1-1-7;
See reverse side (or additional instruction and qualifications. between Janlr�yjl5 a�l,�d¢rch 31 of the year
the deductior/is }� e e%e
GIBSON COUNTY AUDITOR
anWicarrt
on
r. ara[%;
or equifahle awneR Ii No, what is
❑Yes ❑No
�t than that oF applipnt, indicate below
Narne ot contracl seller (applicant must have been
Address of contract seller
'tg disVicl
��-14-��
Is the property used and ocapied primanly fw
hislher residence?
Was ihe applirant 65 years oT age w more on Dea
priw to the curre�l yeaR
ApplKanPs date oi
If filed by a surviving, unmarried spouse, what was
the tlme of death?
Y�
you
any
nng on contract at
:ey number / Legal
.�ni_,c�
❑Yes ❑No
mber:31 of the year
es ❑No
age
❑Yes ❑No
any other county?
�
exact Sha�e w
one (1) year)
with someone othe� Nan spouse,
wiUf whom
�prpperty m queSGOn: �
❑ Real propr.rty ❑ Mobile home (I.C. 6-1-1-n
Remrd number Page number
'�XJ'� I
sed value of the property as
�d 814a.000)
Dces the wmbined annual adjustetl gross fncor
irMividuals sharing ownership exceed E25,000?
_
❑Yes ❑No I
IlWe certify under penalty of perjury ihat the above and foregoing info�+*+=i��n is true and correct and that the applicanl was a resideni
of Indiana and owner of lhe aforementioned property on March 1, 20 _
pnature of apd��l n n/ i� . Signature ot autliorized representaWe (by erecuted Poxrer olAttomey)
apqicant
,.;'
Address of