HomeMy WebLinkAboutAge_PughAFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, couNTV TOWNSHIP ven,rx
REQUESTING DEDUCTION FROM ASSESSED VALUATION n 9 i
S,� State Fortn 43708 (R5 / 603) V�7 � i
Preuribed by Ne DepartmeM of local Govemment Finance
g Fiie�Ma
Infortnation contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-72-9. ��� p,�
INSTRUCTIONS: FILING D S:
1LJ
To be filed in person or by mail with [he Counry Auditor o/ the county where 1) Real propert}�jQu�in� tf�e i�y�qnths before May
the property is Ixated. i1 of the ea1�Ir��dedu�ti67f�i�Yo be effective
See reverse side for additional instiuction and qualifications.
Name of
name on
conVact seller
contract buyer)
❑ No
been
Addreu of conVaG seller
g strict
����
Is the property used and occupied primarily for
hisRier residence?
Was the applicant 65 years of age or more on Dec�
prior to the current year?
ApplicanYs
the tlme of death?
Have you filed for any other deductions?
Have you filed for deductions in any olher county?
rying on contract at least one (7
Key number I Legal description
�/%D��G -
Assi
exce
f�Yes ❑ No
�ber 31 of the year poe
f indi�
� Yes ❑ No
ie spouse's age at
❑ Yes ❑ No
❑ Yes ❑ No
or
Y
2) Mobile mes assessed�ynder I.C.6-1�1-7;
6etwe Janua 13 and�March 31 ofthe year
the d e%sliecfiJe:-�
� GIBSON CQUNTY +-;1DITOR �,��`
'�/'
I vnN someone
vnth whom
Is the property in question:
❑ Real properry ❑ Mobile home (I.C. 6-7-7-n
Record number Page number
property as of March 1, currenl year (may nol
the combined annual adjusted gross income ot the applicant and any
luals sharing ownership exceed 525,000?
p Yes ❑ No
If Yes, what
Source of Income
Yes, what county?
$
s
TOTAL 5 �
INVe certify under penalty of perjury that the above and foregoing information is Irue and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
gnature of applicant � I Signature of authwized representative (by ezecuted Power ol AttomeyJ
/?�iu � , {yl / �U
ss of appl��i,a/nt ,
7i� s /(a « P�,H �� �..