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� AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
REQUESTING DEDUCTION FROM ASSESSED VALUATION
�'` W� � SpteFwm43708(RS/6-03)
� Piascribed by Ne Department of Laal Govemment Finance
Infortna6on co�Wined in this document is CONFIDENTIAL pursuant to IC 61.1-72-9.
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor ol the county where
the property is located.
See �everse side lor additional insUuction and qualifications.
�COUNTY� TOWNSHIP � YEAR
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JC C 1File Mar7c�
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FILING DALES: � �� � /�
� � i. . . . ; � .��..
1) Real property,;Dunng the.12 months be/ore May
11 of tha year tlie deduction is to be eHeciive.
2) Mobiie Aomes assessed under I.C.6-1-1-7;
between January 15 and March 31 0/ the year
the deducfion is to 6e effective.