HomeMy WebLinkAboutAge_Case: A` n•n
= AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, courm TOWNSHIP ren,R
'� � ` REQUESTING DEDUCTION FROM ASSESSED VALUATION
�> + State Fortn 43708 (R6/4-04)
• Prescribed by ihe Department of Lopl Govemment Finance
File Mark
ation contained in this document is CONFIDENTIAL pursuant to IC 6-7.1-12-9 and IC 6-1.135-9.
INSTRUCTIONS: FILING DATES:
To be filed in person or 6y mail with tbe County Auditor o/ the county where 1) Real prope • Dun t 1 hs efore May
the property is located. 11 of the year the dedu� �e Aeff�ive.
2) Mo6ile homes as d}�n,�er I.C.6-1-1-7;
See reverse side !or additional instruction and oualifications. between January���AA�ro��$ji jof the year
- � tbe deduction is to be eflective.
Name of appiiwnt (owner or wntrect buyer) GIBSO d �
N COUN7Y qU017pq
Is applican e sole I 1 or equi able ovmef.� If No, what is his/her exact share or interest? If owned with someone other than spouse,
' indicate with whom
Q Yes ❑ No
If name on rewrd is diBerenl ihan that of applirant, indicate beiow
Name o( conVad seller (applicant must have 6een buying on contract at least (1J year)
Address of contracl seller Is fhe property in questio�:
❑ Real property ❑ Mobile home (I.C. Ef-1-7)
Taxing istrict Key number / Legal description Record number Page number
D/��'- G��e�O -�
Is the property used and occupied primarity for Assessed value of the property as of March 1, current year (may not
hislher residence? ezceed 3144,000)
Yes ❑ No
Was the applicant 65 years of age or more on December 37 of the year poes the combined annual adjusted gross income of the applicant and any
prior to the current year? individuals sharing ownership exceed $25,0007
Yes ❑ No ❑ Yes ❑ No
ApplicanPs date of birth (monfh, day, yearJ
Have you filed for any other deduUions? I( Yes, what deducUons?
❑Yes ❑No
Have you filed tor deduUions in any other county? If Yes, what counryl r
❑ Yes ❑ No :
IlWe 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 applicani Signature of authorized representative (by executed Power olAttomeyJ
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ess of applicaN � Address of authorized representative
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