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Age_Skelton° n. 1 AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, couNTV TOWNSHIP veaa
°'� ` jP REQUESTING DEDUCTION FROM ASSESSED VALUATION
S,��� ! State Fortn 43708 (R6 / 4-0d) � }� if �
A @
Prescribed by Ne Department ol Local Govemment Financa d g
J` 'i--� -FlIe.Ailar
�rmation wntained in this document is CONFIDENTIAL pursuant to IC 6•1.7-12-9 and IC 6-1.1-35-9. `
INSTRUCTIONS: FILINGDATES:�UN O s ZOO6
To be filed in person or 6y mail with the CountyAuditor of the county where
the p�operty is located.
See �everse side /or additional instruction and qualifications.
1) Real property: Du�ng the 12 months before May
11 of the year fhedeductlon is to be effective.
2J Mobi(g��omes�asse 7ed underLC.6-i-1-7;
befween January�l5 and�INaYofiF31 o/the year
the deduction is to 6e effective.
Name of applicant (owner or conVact buyer) �
A' �.��J C-.�-ci ��C, � �
Is applicant the sole legal or equitable owner? If No, what is his/her exact share or interest? 1� owned wifh someone other than spouse,
' indicate with whom
❑ Yes � No
If name on record is diBerent than that of applicant, indicate below
Name of contrad seller (appliwnt must have been buying on conUact at leasf one (1) year)
Address of contract seller Is the property in quesUon:
al property ❑ Mobile home (I.C. 6•7-7-�
Taxi district Key number / I.egal desuiption Rewrd number Page number
a0/-�0�9�-�
Is the property used and occupied primarily for Assessed value of the properry as of March 1, cunent year (may not
hismer residence? exceed 5744,000)
s ❑ No
Was the appliwnt 65 years of age or more on December 31 of the year
Have you filed (or any other deductions? Ii Yes, what deductions?
❑ Yes o
Have you filed for deductlons in any other county? If Yes, what counry?
❑ Yes o
INVe certify under penalty of peryury that the above and foregoing information is true and correct and that the applicant was a resident I
of Indiana and owner of the aforementioned property on March 1, 20
Signature of applicant . Signature of authorized representative @y executed Power olAttomeyJ
i.
�j«.��� � �%�; � �
��ess`�of applicant � �- Address of auihorized representative
3 � �