HomeMy WebLinkAboutAge_DavisRN � AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
REQUESTING DEDUCTION FROM ASSESSED VALUATION
�` � State Fortn 43708 (RS / 6-03)
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' Prescnbed by the Department of Laal Govemment Finance
In(ortnation contained in ihis document is CONFIDENTIAL pursuant to IC 6-1.1-72-9.
INSTRUCTIONS:
To be filed in person or 6y mail with the Counry Auditor of the county where
the property is located.
See reverse side for
ellective.
GIBSON COUNTY
I Is the praperty in questian:
Jd'Fieal property ❑ Mobile home (I.C. 6-1-7-�
number / Legal desaiption Record number Page number
b Yes ❑ No
imber 31 of the year
❑ No
ed by a surv'rving, unmarried spouse, what was lhe spouse's age at
time of dea[h?
Have you filed for any oNe� OetlucUi
Have you filed for deductions in any
❑Yes ❑No
❑ Yes
value ot Ne property as of March 1, current year (may not
aa.000�
Does the combined annual adjusted grass income ot the applicant and any
individuals sharing ownership exceed 525,000?
� � �
I/We certity under penalty of perjury that the above and foregoing information is true and conect and thal the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
3 ature o applicant Signature of authorized representative (by executed Power o/Attomey)
/1 � . �-. �L.
Address of authorized representative
bdia s,