Age_Greer�
�n g AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
�" = REQUESTING DEDUCTION FROM ASSESSED VALUATION
� .•N / Slata Fortn 43708 (Ra / 10-01)
Prescribed by Ne Department of Local Govemment Finance
�rtnafion conlained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9.
INSTRUCTIONS:
To be filed in pe�son or by mail with the County Auditor of the county where
the property is located.
See reverse side foradditional insfrucfion and qualifications_
of
Ihe sole legal or equitable owner?
�'�s ❑ No
If name on record is diHerent than Ihat of aoolican
must have been
Address of conUad seller
� ���N w ' �
and ocwpied primarity for
was the appiicant s5 years of age or more on
prior to the curtent year?
day, year)
� ' � �
If fJed by a surviving, unmartied spouse,
the time ot death7
Have you filed for any other
you
any olher
If No, what is hisRier
on contract at leasf one (1) yeaiJ
Key number / Legal description
CO �- =�_a S�.a
�
exa
❑ Yes ❑ No
mber 31 of the year poe
ind'n
s ❑ No
was the spouse's age at
❑ Yes
C UNTY TOWNSHIP YEAR
V 4�
ark
FILING DATES:
1J Real property: During the 12 month,s 6efore May
11 0l the year the deduction is to be effective.
2) Mobile homes assessed unde�l.C.6-1-1-7;
between January 15 and March 31 of the year
the deduction is to be effective.
mdicale with eJkom g �� �� ��
M��IBBI-
GIBSON COU�JTY qUD170R
Is the property in question:
eal property ❑ Mobile home (I.C. 6-1-7-n
Rewrd number Paqe number
;tl value oi the property as ot Marrh 7, cuvent year (may not
869, 000)
e wmbined annual adjusted gross income of ihe applicanf and any
als sharing ownership exceed 525,000?
❑ Yes ❑ No
If Yes, what county�
I/We certify under penalry of perjury that the above and foregoing infortnation is true and correct and that the applicant was a resi-
dent of Indiana and owner of lhe aforementionad propeAy on March t, 20 _
alure pplica � Signature o( auNorized representative (by executed Power ofAttomey)
of aulhorized representative
%