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F AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, couNrr TOWNSHIP vEn,R
REQUESTING DEDUCTION FROM ASSESSED VALUATION -
S,u� � State Fortn 43708 (RS / 6-03)
Prescribed Ey Ue Department o( Lofal Govemment Fnance
File Mark
Intortnatlon contained in this dowment is CONFIDENTIAL pursuant to IC 6-1.1-12-9.
�RUCTIONS: � � � �'�ILI�TES:
To be filed in erson or b mail with the Coun Auditor of the coun he �r-�
P Y �Y ��f) ea roperty: During the 72 months before May
the property is located. o) fh y,ear the deduction is fo be effective.
N�� 3 Z��Mo6ile�'dire��s�ess� ,�G.6���-7;
See reverse side for additional instiuclion and qualifications. bet�e�eJ9hndl�(z1 � �� �farc ��'�� �o t e year
�` ��1 the de ct� �to be eflec�e. °f transFer
Is apoliwnt
name on recom is amerent than mat c
ame of conVact selier (applicant must
ddress of conVact se�ler
axing district �
P�m
No, what is hisRier exad share or interest?
❑ No �
appliwnt, indiwte below
e property used and occupied primarily for
,er residence?
Was the applicant 65 years of age or more on I
prior to the curtent year?
Applicani's date
spouse's age at
❑ Yes ❑ Na
Avditor
Gibson Countv
oNer ihan spouse.
Is the property
0 Real propert/ ❑ Mobile home (I.C. 6-1-7-n
I value of the property as
744.000)
7, curtent year (may not
combined annual adjusted gross income oi the applicani antl any
s sharing ownership exceed 525,000?
❑ Yes ❑ No
$ �
O Yes ❑ No �
I/We certify under penalty of perjury that the above and foregoing information is true and conect and [hat the applicant was a resident
of Indiana and owner of the aforementioned property on March t, 20
Address