HomeMy WebLinkAboutAge_Driskelld,••°'"o� AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
:�; REQUESTING DEDUCTION FROM ASSESSED
VALUATION State Form 43708 (1-90) Prescribed by the
°• State Board of Tax Commissioners
�
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 12 months before May 11 of the year the deduction
is to be effective. Deductions for mobile homes not assessed as real property
mustfile betweenJanuary 15 and March 31. See reverse foradditional instructions
and qualifications.
Applicant (Owner or contract �aqer� (�
County Township Year
/ ��
File Mark
�I D
APR � 1 1997 �
GIBSON
Is applicant the s�ole legal V If n��at is his/her exact share or I If owned with someone other than
�
equitabie owner. yes ❑ no inte t. spouse, indicate with whom.
If name on record is different than that of applicant, indicate below:
contract seller (Applicant must have been buying on contract at least one (1) year.)
Address of contract seiler
Is the real property used an ccupied primarily
for his/her residence? yes ❑ no
Was the applicant 65 years of age or more on
Dece r 31 of the year prior to the current year?
es ❑ no
Does the combined annual adjusted gross
income of the applicant and any individuals
sharing owner ip exceed $t�.r,9@@9'
Oyes no aO,OOo
Have you filed for any other deductions?
Have you filed for any deductions in any other county?
=� (J � Page No.
Assessed value of the property as of March 1, current
year (may not exceed $19,000).
ApplicanYs date of birth �—(�_
If filed by a surviving, unmarried spouse, what was the
spouse's age at the time of death?
yes,
Amount of income
Total / %j 3p.3
If yes, what county?
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the appli=:
cant was a resident of Indiana and owner of the aforementioned property on March 1, 19 '
Signature Authorized Representative (by executed Power of Attorney)
ss of Applicant 1
Q- O�. �e�� r k s7