Age_Gaston (3),°� �_rt�• � AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, courm TOWNSHIP venR
' REQUESTING DEDUCTION FROM ASSESSED VALUATION
S � State Fortn a3708 (R6 / 4-0a) '
• Prescribed by Uie Dapartment of Lowl Gwemment Finance
.. rmation wntained in this document is CONFIDENTIAL pursuant to IC 6-1.1-72-9 and IC 6-1J-3
� ile ark
INSTRUCTIONS: F� �TES:
To be (led in person or 6y mail with Ihe CountyAuditor of the county where 1) Realg�p�er(�: �uQ�g'jihe 12 months betore May
the property is located. 11 of the year the deduction is to be e/fective.
2) Mobile homes assessed under I.C.6-i-1-7;
See reverse side Ior additional instruction and qualifrcations. 6ehveen ,taau� JSsand Maroh 31 of the year
G BSON Cou�{�isl�oA�+e�effective.
Name of applicant (owner or o tracf buyer)
Is applicant the sole legal or equitable ow e?
es ❑ No
If name on record is diBerent than fhat of applican
wnVact
of
property use
r residence?
seller
on contracf af
❑ Yes ❑ No
the applicant 65 years of age or more on December 37 of fhe year
to the current year7
❑ Yes ❑ No
�-
If filed by a surviNng, unmartied spouse, what was the spouse's age at
the time of death?
Have you 61ed for any other deductions?
❑ Yes ❑ No
you
any
or
one (i) year)
I with someone other than spouse,
with whom
Is the property in question:
❑ Real property ❑ Mobile home (I.C. 6•1-1-7)
Rewrd number Paqe number
Assessed value of the property as of March 7, current year
exceed $144,000)
OOeS Ne tOmbinetl annUal atljUSteC gro55 infA�
individuals sharing ovmership exceed 525,0007
--
❑ Yes ❑ No �
IMIe 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 _
of a¢bliCSnt —' "� Address of authorized representalive
� a F[�.,� �� �P �►., � �,_ ��