Age_ShermanI� �
°•�•`= AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
Y. .
'� � REQUESTING DEDUCTION FROM ASSESSED VALUATION
>� i State Fortn 43708 (R6 / 4-06)
Prescnbed by the Department of Local Govemment Finance
I�rmation wntained in this document is CONFIDENTIAL pursuant lo IC 6-1.1-12-9 and IC 6�5-�
�
INSTRUCTIONS:
To be filed in person or 6y mail with the CountyAuditor of the county where
the property is located.
See �eve�se side fo� addilional instruction and qualifications.
YEAR
File Mark
FILING DATES:
1{i'��i! F}o�er�Q�Lnng the 12 months before May
11 0( the year the deduction is to be effective.
2j-��iile hqg� assessed under 1.C.6-1-1-7;
�6� ,t`J�ry 15 and March 31 of the yea�
GIBSOI�i�2�oq�p� e/%ctive.
Name of appli n(owner or contract buyer)
Is applicanf the e legal or equitable owner? If No, what is hislher exac share or interest? If owned with someone other than spouse,
' indicate with whom
Yes ❑ No
If name on record is different th n ihat of applicant, indicate beiow
Name of contract seller (applic t must have been buying on contract t least one (i) year)
Address of contrad seller . Is the property in question:
❑ Real property � Mobiie home (I.C. 6-1-1-n
nn isGict Key numbe / Legal description Record number Page number
�� ! - i>a?53-�v
Is lhe properry used and occupie primad�y for Assessed value of the property as of March 1, current year (may not
hismer residence? exceed 3144,000)
es ❑ No
Was Ihe appliwnt 65 years of ag or more on December 31 the year poes the combined annual adjusted yross inwme of the applirant and any
prior to the current year? individuals sharing ownership exceed $25,000?
es ❑ No� ❑ Yes ❑ No
AppliwnPS date
$
Have you �led tor any other deductions? If Yes, what deduc6oas?
❑ Yes ❑ No
Have you filed for dedudions in any other countyt If Yes, what counTy?
❑ 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 resident
of Indiana and owner of the aforementioned property on March 1, 20
ignawre of appiicant Signature of authorized representative (by cxecuted Power o/Attomey)
� � ss of appliwnt . Address of authorized represeniative