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"a AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
� �' - 4 REQUESTING DEDUCTION FROM ASSESSED VALUATION
�
.�� j,�� ` State Fortn 43708 (R3 / 8-00)
�, Prewibed by the State Board of Ta�c Commissioners
�mation contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-72-9.
INSTRUCTIONS FOR FILING:
To be filed in person or by mail with the County Auditor ol the county where the property is loca
ted during the 12 months be%re May 11 of the year the deduction is to be eHective.
Deductions for mobile homes not assessed as 2a1 property must file between January 15 and
March 31.
See reverse side loradditional instruction and qualifications.
name on
or equitable owner If No, whal is
O No
ant than that of appiiwnt, indicate below
COUNTY TOWNSHIP YEAR
e a
MAY 0 9 2001
GIBSON COU!��� .F���
exad share or interest? If owned with someone
indiwte with wham
Name of contract seller (applicant must have been buying on contrect et leest one (1) }rea�)
Address of contwd seller ,
Taxing disVid '. number I Legal descriptio —r /.r
�� �G17-Od�33-o0 ,,- .
�ariy �or his�her residence?
s the appliwnt 65 years of age or more on
a to the wrrent yeaR
rlicanPs dale of birth (month, day, yearJ
ed by a surv'rving, unmarried spouse, whaf
time of death?
�e you filed for any other deductions?
spouse,
number
�Asse� �+jalue of the . � �arch 1, wrtent year (may
.excee �00)
Y] s ❑ No � � �
(r. +.r 37 of the year v-_ : combine � ! .i ed gross inco�
� di� � ��Is sharinc : ,i ;eed 525,0007
L ❑ No �
—�
� � _ Souree of ncome �
was the spouse's age +
!.. .r.�t- �
_�w
• ' F:
what ded� �e
�
❑ Yes ❑ No �
you filed for dedudions in any other county7 If Yes, what count�?
and any
❑ Yes �
Amount of Income
� Yes ❑ No �
I/We certi(y under penalty of perjury �that the above and foregoing infortnation is true and correct and that the applicani was a resi-
dent of Indiana and owner of the aforementioned property on March 1, 20 _
representaWe (by executed