HomeMy WebLinkAboutAge_Stewart°` °'°o AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, courirv TOWNSHIP VEAR
ee ' REQUESTING DEDUCTION FROM ASSESSED VALUATION
�, ��' Stare Form 43708 (R / 9-96)
"� ` Prescribetl �y the State Board of Tae Commissioners
File Mark
Intormation contained in this document is CONFIDENTIAL pursuant to IC 6-1 J-12-9.
INSTRUCTIONS FOR FILING: �\
To be liled in person or by mail with the County Auditor ol the county where the property is loca- �� �� ;�1 ;%
ted during the 72 months beJore May 77 0) the year the deduction is to be e/fective.
Deductions lor mobile homes not assessed as real properry must tile between January 15 and Mqy p 3 1999
March 31.
See reverse side lor additional instruction and qualilications. �' � � „ n
or contract
% �
appJyaN tne soie iegai or
��
name on record is ditterert
ame of contracl seller (app
idress of coniract seller
/ v
d�Yes ❑ No
and oCCUpied primarily for
on Contract at least one
number /
❑ Yes ❑ No
the applicani 65 years ot age or more on December 31 of the year
to the current year?
time of
you
of birth (month, day. year)
spouse,
�
or deductions in any m
was the spouse's age at
❑Yes ❑No
GIBSON �UtfTY hUDiTOft i
owned with someone other ihan spouse,
dirate with whom
�
e5�iC5 �.�[�/L �^'
p_a�.c.�r#p -�[.t/U �
number IPaaenumber
the property as of Ma¢h 7, current year (may not
❑ Yes ❑ No
combined annual adjusted gross income of the applicant antl any
s sharing ownership exceed $20,000?
Source of Income
county?
�
$
TOTAL $
❑ Yes ❑ No
Amount of Income
❑ Yes O No �
1/We certify under penalty of perjury that the 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 1, 19 �
iaWre of applicant Signature of authorized representative (by executed Power olAttomey)
(-.r`�y� L •
ress of app nt _ Address of authorized represeniative