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AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, cou wris r
REQIPESTING DEDUCTION FROM ASSESSED VALUATION
:�w J SYete Form 43708 (R7 / 5-06)
a� ny me o�,�t w�a G���t F� E B O 2O
File Mark
��rmation wntained in Ihis document is CONFIDENTIAL pursuant to IC 6-1.7-72-9 and IC 6-'1.1-35-9. �-y� �
p �t
INSTRUCTIONS:
To be �led in person or by mail with the CouniyAuditor the `county yvl,{�
the property is located. � V�` n
/ o�
See reverse side for additional instruction and qualifcatio �\J
�
of appticaM
the sole legal or
name on
�
❑Yes ❑No I
ian that of applinnt, indicate
!ame of contract selier (applicant must have 1
ddress of contracl selier
l.+
istrict_ —
� Me ProPenY used and ocaPied Primarily to
islher residence?
Yas ihe appiipnt 65 years of age or more on
rio� to the arrenl year?
�
e Ume of death?
ave you filed for any other
you filed
spouse,
any
an
exac[ share w interesC?
at least one (7) year)
FILING DATES: GIBSON COUN� qU01T� R
1) Real property: During the 12 months before �une
11 of the year the deduction is to be eflective.
2) Mobile homes assessed under I.C.6-1-1J;
j between January 15 and Ma�ch 31 0l the year
t he de duc tion is to be e ffective.
If owned with someone other than spouse,
indirate wiUt whom
� Is the property in queslion: �
Real property ❑ Mobile home Q.C. E7-1-�
Key number / Legal desuiptlon Record number Page number
a��-ia -o� -303 -ooa a��-
. Psussed value of ihe property as of March 1, current year (may not
� ezceed 8144,000)
�1'es. ❑No
Decembec37 of the year
�l'es ❑No
was itie spouse's age at
❑Yes ❑No
my?
❑Yes ❑No
�mbined annuai adjusted gross income of the applicant and any
sharing uwnership exceed E25,000?
Source of Inwme
SS .�.�-�•
If Yes, what
❑Yes ❑No
Amount of Incoi
$ /7,088
$
TOTAL � $
I/We certify under penalty of perjury ihat the above and foregoing info�**+=}��n is true and correct and that the applican[ was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
`� ��,�,�, ,N p
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representative (by
represenWtive