HomeMy WebLinkAboutAge_Cain,.��:q AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
d'� �{s REQUESTING DEDUCTION FROM ASSESSED VALUATION
' ' State Fortn 43708 (R2/72-99)
r�• ' _
_e_�, e Prescnbed by the State Boartl of Taa Commissioners
Information contained in ihis document is CONFIDENTIAL pursuant to IC 6-1, 7-12-9.
INSTRUCTIONS FOR FILING:
To be filed in person or by mail with the County Auditor of the county where the property is
located during the 72 months before May 11 of the year the deduction is to be effective.
Deductions for mobile homes not assessed as real property must file between January 15 and
March 31.
See reverse side for additional instruction and quali/ications.
rvame m ap nt �owner or comract t
. � n
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Is applicant the sole legal or equitable
If No, what is his/her exact share or interest?
� res ❑ No I
If name on record is difterent than that of applicant, indicate below
Name of conimct seller (applicant must have been buying on contract ai leasi one (1) year)
n� .. <� . .
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Address of contraci seller
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Is ihe real property used and occupied
primarily for his/her residence?
Key number / Legal descripiion
COUNTY TOWNSHIP YEAR
����a�
JAN082001
GIBSON COUNTY A��
If owned with someone other than spouse.
indicate vnih whom
Record number I Page number
Assessed value of the property as of March 1, current year (may not
exceed 523,000)
Yes ❑ No �%f p D O
was me appucant tis years ot age or more on uecemoer si oi tne
�ear prior to ihe curreni yea(?
�f Yes ❑ No
ApplicanYs date of birth (month, day. year)
�
If filed by a surviving, unmarried spouse, what was ihe spouse's age
at the time of death?
Have you filed for any other
❑ Yes �No
uoes me comomea annuai aa�ustea gross mcome or me appucan[ ana
any individuals sharing ownership exceed 525,000? � �
❑ Yes �No
Source of Income Amount of Income
If Yes, what deductions
S
3
TOTAL I S
❑ Yes lo I
Ve certify under penalry of perjury Ihat the above and toregoing information is We and correct and thai the applicani was a resident
Indiana anSLnwner of the aforementioned property on March 7, 20=
Signature of authorized representative (by executed Power of Attomey)
Address of auihorized representative