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aj "''v AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
}� = REQUESTING DEDUCTION FROM ASSESSED VALUATION
Y, �• Stare Porm a3708 (R / 9-96)
�'',�"�' Prescribed by ihe Stare Boartl ot Tax Commissioners
Information contained in this documeni is CONFIDENTIAL pursuani to IC 6-1.1-12-9.
COUNTV TOWNSMIP YEAR
F' r
INSTRUCTIONS FOR FILING.
To be liled in person or by mail with the Counry Auditor ol the county where the property is loca- y 0 � � 5 �998
ted during the 72 months be%re May 77 0l the year the deduction is to be eJlective. ^ /�
Deductions !or mobile homes not assessed as real property must file between January i5 and � !..,�, J/
March 31. � - ) . �"""�`
See reverse side lo� additional instruction and qualifications.
, ,IBSON �iJ� TY AUDI70R �
name on
II
seller
� district
�r�ncQ
property used ai
r residence?
or conUact buyerJ
I I I�
or eq table owner? It No, what is
Yes ❑ No
�nt than ihai of applicant, indicate below
exact share of interesl? If owned with someone other than spouse,
indicate with whom
must have been buying on conhact at least one (7) year)
Key number / Legal descnption
� I S-0/�a8 �
s tne appucant es years ot age or more on uecember 3
r to the curreni year?
ilicanfs date
ed by a surviving, unmarried spouse. what was the spoi
time of death?
�e you filed for any other deductions?
❑ Yes
�e you filed for deduciions in any other couniy?
A55essetl value ot Ihe property as of March t, curreni year (maynot
exceed $21,000)
❑No /�n7� �Yes ❑No
he year poes ihe combined annual adjusted gross income the applicant and any
individuals sharing ownership ezceed $20,000?
age at
If Yes, what
� No
If Yes, what
❑ Yes No
Source o1 Income Amount oi Income
$ a3s
$
TOTAL $
❑ Yes �No
,
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant was a resi- ��
dent of Indiana and owner of the aforementioned property on March 1, 19
>s of appli � ' Address of authorized representative
�,�� �,��� C�,