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AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, couNTV TOWNSHIP r�+a
REQUESTING DEDUCTION FROM ASSESSED VALUATION
State Fortn 43708 (RS / 6-03)
PrasaiEed Uy ihe Department of Local Govemment Finance
InfortnaUon contained in this document is CONFIDENTIAL pursuant to IC 61.1-72-9.
INSTRUCTIONS:
To be fifed in person or by mail with the County Auditor ot the counry where
ihe property is located.
See reverse side lor additional instiuction and qualifications.
File MarTc
FILING DATE� � � �
7) Real property: D The 1 Q� before May
11 of the year the d�educt)lbrci� be eHective.
2) Mobile homes assessed�under I.C.6-1� 1-7•�
between ,lanuary 15.and Maich 31 of�the year
the deducgoqisYO b'e;�' ec�iv�e.
I,IdJVN LUI��+� * til!DITOR
Name of applicant (owner or contract buyer)
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Is aoolicanfthesoleiegel�or'e uitable own r If No, at is his/her exact share w interest? If owned with someone other than spouse,
indicate with whom
es ❑ No
If name on record is different than Nat of appliwnt, indicate be�ow
Name of contract seller (applicant mus7 have been buying on contract at least one (1) year)
Address of conVact selier Is the property in question:
I property ❑ Mobile home (I.C. 6-7-1-n
�ing disVict � Key number / Legal description Re rd number Page number
��� C���a=��'b� - � _ �-CX�
Is Ne property used and occupled primarily for — Assessed value ot Ne pmperty as ot March 1, wrrent year (may nol
his/her residence? exceed 5144,000)
S ❑ No
Was the applicant 65 years of age or more on December 31 of the year
$ �
Have you filed for any olher deductions? If Yes, what deducUons?
❑ No
Have you filed for deductions in any other county7 If Yes, what county?
❑ Yes
I/We certify under penalty of perjury that the above and oregoing information is We and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
Signature pplicant Signature of authorized representa6ve (by ezecuted Power o)Attomey)
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r o( ppli t Address of authorized representative
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