Age_Anderson/� ' �• •n�
`4 AFFIDAVIT OF PERSON,_65 YEARS OF AGE OR MORE,
' . REQUESTING DEDUCTION FROM ASSESSED VALUATION
'���2, State Fortn 43708 (R6 / 4-Oa)
Presaibed by Ne Department ot Lowl Govemment Finance
��ation conlained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.1359.
COUNTY TOWNSHIP ^/YEAR
� W a�
File ar
JAN 1 9 Z006
INSTRUCTIONS: FILING DATES�
To be filed in person or by mail with the CountyAuditor o/ ihe county where 1) Real property.��� g the onths before May
the property is located. 11 0/ the year fhe'�� to be effective.
2) Mobile QfB��y�p���u /,�.§-1-1-7;
See reverse side fo� additional instruction and qualifications. between January 15 and Marcii'�f of the year
the deduction is to 6e eflective.
C
ovmeR I If No, what
QYes ❑No
name on
share or
ot contract seller (applicanf must have been buying on wntract at least one (1) year)
'`�y
�� �,�� ��
❑ Yes ❑ No
Was Ne applicant 65 years of age or more on Decem6er 31 of the year
prior to fhe current year?
❑Yes ❑No
I( filed by a surviving, unmarried spouse, what was the spouse's age a[
the fime of death7
you tnea tor any
Have you filed for deductions in any oiher countyl
❑ Yes ❑ No
❑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 _
,( � -r. C . Q.ri,o��vior-
,ess of applica� �� a
R R � s-�,
l y'I 6'I 7
gyBSE 9005 pl���
.
• y�� 7 � � ,-�?��
,
Address o( authorized represenlalive
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