HomeMy WebLinkAboutAge_Tooley"ai AFFIDAVIT OF PERSON� 65 YEARS OF AGE OR MORE� CO N1Y TOWNSHIP YEAFt
REQUESTING DEDUCTION FROM ASSESSED VALUATION �
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State Fwm 43708 (R3 / 8-00)
Prescribe0 by the State Board ot Ta�c Commissbnen y
In ormation coniained in this document is CONFIDENTIAL pursuant to IC 6-7.1-12-9.
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INSTRUCTIONS FOR FILING:
JUN 2 7 2001
To be filed in person or by mail with the County Auditor o( the county where the propeRy is loca-
ted during the 12 months be(o2 May 11 of the year the deduction is to be effective.
Deductions /or mobile homes not assessed as 2a1 property must file 6etween January 15 and GIBSON COUMTY AUDI70R
March 31.
See reverse side lor additional instruction and qualifications.
Name of piicant (ownerorcontract buyer)
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Is appliwnt the sole legal or equitable owneR I No, w at is hisRier exact ha or interest7 If owned with someone other than spouse,
indicate with whom
❑Yes ❑No
If name on record is dit�erent than that of appiiwnt, indipte below
Name of contrad selier applicant must have been buying on oontract at least one (1) year)
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Address of contrad eller
T�.ing{q'�st��id ,�J Key number / Legal description Record number Page number
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Is the real property used and occupied Assessed value of the property as of March 7, current year (may not
primarity for hisTher residence7 exceed 569,000)
❑ Yes ❑ No
Was the applicant 65 years of age or more on December 31 of the year
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Have you filed for any other deductions? I( Yes, what deductions?
❑ Yes B�
Have you filed for dedudions in any other county? If Yes, what county?
❑ Yes L�'No
IM/e certiy under penalty of perjury that the above and foregoing information is true and wrred and that the applirant was a resi-
dent of Indiana and owner of lhe aforementioned property on March 1, 20 _
Signature o( applicant Signature of author¢ed representative (by execufed Power o/Attomey)
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.ress of ap lica�t � Q, i�_ ___ Q r Address of authorized representative :
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