HomeMy WebLinkAboutAge_Wright��t AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, courm TOWNSHIP vFaa
� REQUESTING DEDUCTION FROM ASSESSED VALUATION
�+ ? SWte Fortn 43708 (R6 / 4-Oa)
�a.
Prescribed by Ne Deparlment of Lowl Govemment Finance
� �"� � �ile Mark
InformaUon contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.7 N �� �
INSTRUCTIONS: FILING S. �
To be filed in person or by mail with the County Auditor o/ the county where �) ����e�jy�Qu�g the 12 months 6etore May
the property is located. 1� e�6r 1,�� eduction is to be elfective.
2) Mobile homes assessed under I.C.Ef-1-7;
See reverse side (or additronal instruction and qualifications. �it,Wegn J��ary 15 and Ma�ch 31 of the year
�e deduchon is7to be e8ective.
GIBSON COUNTY AUDITOR
Name of auolicaai(owner or contract bwed n � �
Is applicant the sole legal or
❑Yes ❑No
name on
Name of contract seller (applicant must have been
property
exad
on cont2ct at /east one
❑ Yes
Was the applicant 65 years of age or more on December 31 of
prior to the current year? �
�
❑ No
�e year
❑ No
AppliwnPs date
If fded by a surriving, unmarried spouse, what was the spouse's age at
Ihe fime of death?
Have you 51ed for any other deductions?
� ❑Yes ❑No
you
any
❑Yes ❑No
or
I vrifh someone
with whom
Is the property in question:
spouse,
❑ Real property ❑ Mobile home (I.C. 6-1-1-n
Record number Page number
�a3�a� � �
Assessed value of the property as of March 1, current year (may not
exceed $144,000)
Does the combined annual adjusted grou incor
individuals sharing ovmership exceed $25,0001
of Income
If Yes, what deductions?
ne ot the applicant antl any �
❑ Yes ❑ No
Amount of Income
$ �331$. .. - _. .
$
TOTAL I $
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant was a resident
of Indiana and owner ot the aforementioned property on March 1, 20 _
of appliwnt Signature of authorized representative (by executed Power olAttomey)
� � � l � �.�