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AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
RE�UESTING DEDUCTION FROM ASSESSED VALUATION
Sute Form 43708(R2172-99)
Prescribed by ihe State Board of Tax Commissioners
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Information contained in this document is CONFIDENTIAI pursuani to IC 6-1, 7-12-9. -N-�� 15�� � �}'t! ! jj �
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INSTRUCTIONS FOR FILING: � � ._
To be (iled in person or by mail witn the County Auditor of the county where the property is t,�AY O p ZQQ�
located during the 12 months before May 11 of the year the deduction is to be effective. ���� �/�
Deductions for mobile homes not assessed as real property must file between Janua�-1 5 and C..h �/ _ D
March 37. l � � i r�-G-�-�
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See reverse side lor additional inst�uction and quali7ications. ri.tµ"� ��: -,�i:�
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Name of applicant ner r coniract buyer)
Is applicani the sole le or equ bl wneR If No, what is his/her exact share or interesi? If owned with someone oiher ihan spouse,
inditate with whom
Yes ❑ No �
If name on record is ditterent ihan ihat of applicant, indicate below .
Name of wntrac seller (applicant must have been buying on contract at least one (7 ) year)
Address of iract seller
�'ng dis t Key number / Le al description Record number Page number
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Is the real property used and occupied Assessed value of ihe property as of March 1, current year (may not
primarily for hishier residence? � exceed 523,000)
Yes ❑ No
Was the applicant 65 years of age or more on December 31 of the
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Have you filed for any other deductions? If Yes, what deductions
❑ Yes �No
Have you filed or deduciions in any other county? I es, what counry.
❑ Yes
WJe certify under penalty of perjury that the above and foregoing intormation is true and correct and thai ihe applicant was a resideni
of Indiana and owner of the aforementioned property on March 1, 20
Signature of applicant Signature of authorized represemative (by executed Power of Attomey)
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Ad ress o plica Address of authorized representative �
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