HomeMy WebLinkAboutAge_Stilwell`�"' t;�AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
:� � REQUESTING DEDUCTION FROM ASSESSED VALUATION
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•S\ �J Slale Fortn 43708 (R3 / 8-00)
�• Presuibed by Ne Siate BoarE ol Tar Commissioners
mation contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9. -
INSTRUCTIONS FOR FILING:
To be filed in person or by mail with the County Auditor o/ the county whe�e the property is loca-
ted during the 12 months be(ore May 11 0/ the year the deduction is to be effective.
Deductions (or mobile homes not assessed as real property must file behveen January 15 and
March 31.
See reverse side lor additional instruction and qualifications.
Name of applirant (owner or contract b
Is applicant the sole legal or equitable i
❑ Yes
If name on rewrd is difterent than that
ime ot contract seller (applicant must
Idress of contrad seller
xin istr
/ �
the rea property used and occupied
imariry for hisTher residence?
the applfcant 65 years ot age or more on
to Ne wrrent yea(1
filed by a
e time of
you
you
.
'
the spouse's age at
❑ Yes No
nty?
❑ Yes Q.Odo
COUNTY TOWNSHIP YEAR
� ol
File Mark
��� � �
FEB 21 2001
� �_,_rp �_�?` GBSON COUNiY qUDITpR
.JJ�/ " '
or in[erest? If owned with someone other than spouu,
indicate with whom
number
Assessed value of the property as of March
exceed 569,000)
year
number
�mninetl annual atljustetl gross income of Ne applicant and any
sharing ownership exceed $25,000? � �
❑ Yes .!d'lao
Source of Income Amount af Income
$ -7379.0 �
� . $r�a��- � b
TOTAL $ � q� a �a . 8 i�
Yes, what deductions?
I/We ceRify under penalty of perjury thal the above and foregoing informalion is true and wrred and that the applicant was a resi-
dent of Indiana and owner of the aforementioned property on March 1, 20 _
ature of appliwnt _ � Signature of authorized representative (by executed Power o/Attomey)
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