HomeMy WebLinkAboutAge_Krieg���"� AFFIDAVIT OF PERSON, 65 YEARS OF AGE.OR MORE,
4 REQUESTING DEDUCTION FROM ASSESSED VALUATION
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Sldte FOrm 43708 (R3l 8-00)
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Prescribed by ihe State Board of Tax Commissioners
Information wntained in this document is CONFIDENTIAL pursuant to IC 6-7.1-12-9.
INSTRUCTIONS FOR FILING:
To 6e �led in person or by mail with fhe County Auditor of the county where the property is loca-
ted during the 12 months be(ore May 11 of the yearthe deduction is to 6e effective.
Deductions (ormo6ile homes not assessed as real propeRy must (le between January 15 and
March 31.
See reverse side lor additional instnictlon and qualifications.
applicant the sole legal or
es ❑ No
name on
o( contrad seller
used and occupied
residence7
� appucant 65 years ot age or more on
Ne wrrent yeaR
spouse's age at
❑ Yes ❑ No
Assessed value
exceed S69.001
MAY 0 9 2001
GIBSON COU�ITY AU�
T— i with someone other lhan spouse,
�e with whom
r
. O
- �r
�
�' ��
Record number
as ot March 1, wrtent year (may not
Does the combinetl annual adjusted gross income ot the appliwnt and any
individuals sharing ownership ezceed 525,000?
es ❑ No
Source of Income Amount of Income
S
$
TOTAL $
� Yes ❑ No �
IIWe certiy 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 lhe aforementioned property on March 1, 20 _
�ature of�pplicant `/ Signature ot authorized representative (by executed Power ofAttomey)
n .
��
0
ot authorized
.