Age_Belld;% °o AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
-` � REQUESTING DEDUCTION FROM ASSESSED VALUATION
f� � � Sta:e Form a3708 (R / 9-96)
��' ',�,—� •"�' Prescribed by the State Boartl oi Tav Commissioners
Information contained in Ihis document is CONFIDENTIAL pursuani to IC 6-1.1-12-9.
INSTRUCTIONS FOR FILING:
7o be fifed in person or by mail with Ihe County Auditor of the county where the property is loca-
ted during the 12 months before May 77 0/ the year the deduction is to be ef(ective.
Deductions /or mobile homes not assessed as ieal property must lile behveen January 15 and
Ma�ch 31.
See reverse side !or additional instruction and qualilications.
Name of applirant (ow o� contract buye�J
Is applicant the sole I gal or equitable ?
s No
If name on record is diHerenit an of applican
Name of contract seller (apPlicant must have bee�
Address of contract seller
'3xing district
�V '
Is the propeny used and occupied primarily for
0
on wnnact at �east one
�'S'es ❑ No
the applicant 65 years of a9e or more on December 37 of the year
ro the current year?
dicam's date
spouse's age at
time of deaih?
you filed for any oiher deductions?
COUNTY TOWNSHIP VEAR
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APR 0 .: 2000
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� CIBSCN �JUfJ� ?;�DI70ri f
witn sameone
with whom
Isy �o I
ssessed value of the property as of March t, currem year
�xceed 321, 000)
❑ Yes
loes the combined annual adjusied gross income of ihe ap
idividuals sharing ownership exceed 520,000?
Yes. what
❑ Yes ❑ No I
you filed for deductions in any other couniy? � If Yes, whai
i
❑ Yes ❑ No '.
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant was a resi-
der(t of Indiapeand owner of the aforementioned property on March 7, 19
y �b10
of authorized representative
(by executed Power olAttorneyJ
. . FILED
•.,;;"w APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR j
_'`''r1 z PROPERTY TAX BENEFITS APR NO
State Form 43708(R9/9-08) .
•' ones Prescribed by the Department of Local Government Finance
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.1-35-9. GIBSON COUNTY AUDITOR
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor of the county where the properly is located.
Filing Dates: 1) Real Property:During the twelve(12)months before December 31 of the year the deduction is to be effective.
2) Mobile Homes assessed under IC 6-1.1-7 or manufactured homes not assessed as real property:During the twelve(12)months
before March 31 of the year the deduction is to be effective.
See reverse side for additional instructions and qualifications.
Type of benefit requested se check all that apply)
Over 65 Deduction from Assessed Valuation Over 65 Circuit Breaker Credit
Name of app/ m(owner or contract buye/,
�(G 5r/`/
Is applicant he sole legal or equitable MV/TA(0 If No what is his/her exact share or interest? If owned with someone other than spouse,
indicate with whom
❑ Yes ❑ No
If name on record is different than that of applicant,indicate below
Name of contract seller(applicant must have been buying on contract at least one(1)year)
Address of contract seller(number and street,city,state,and ZIP code) Is the properly in question:
x I Real property ❑ Mobile home(IC 6-1-1-7)
Taxing �
,y� Key number/yLLegal descritption/y1 `t ,r Record number Page number
Is the property used and occupied primarily for
❑ Yes ❑ No
INJe 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 of the aforementioned property on March 1,20 .
Signature of applicant dress of applicant (number and street,city,state,and ZIP code)
Signature of authorized repres 6e C-'•�/
_
r Address of authorized representative (number and street,city,stale,and VP code)