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i �_, � AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR M.ORE, courm TOWNSHIP vea,R
REQUESTING DEDUCTION FROM ASSESSED VALUATION �
�' � State Fortn 43708 (R6 / 4-Oa) '
•• Presmbed by the Oepartment of Lotal Govemment Finance
File Mark
�rmation wntained in ihis document is CONFIDEN7IAL pursuant to IC 6-1.1-72-9 and IC 6-1.7•35-9. �UN �$ 2���
INSTRUCTIONS:
To 6e �/ed in person o� by mail with the County Auditor ol the county where
the p�operty is lowted.
See reverse side Ior additional instrucfion and quali�cations.
FILING DATES:
1) Real property: Dud3q th�l �onths before May
17 0/ the year fhe ded�`uction �to be effective.
2J Mobile hpBYg�gs3�8StiaYuideBYT06-1-1-7;
between January 15 and March 31 0l the yea�
the deduction is to be ef/ective.
Name of applicant (owner or conVacf buyer� �
C/
Is applirant the sole lega or equitable ow�en If No, what is hislher exact share or interest? If owned with someone other than spouse,
' indiwte wiih whom
Yes ❑ No
If name on rewrd is diBerent than that of applicant, Indicate below
Name of contract seller (applicant must have been buying on confract af least one (7) year)
Address of convact seller Is the property in ques6on:
❑ Real property ❑ Mobiie home (I.C. 6-1-1-7)
Taxing district Key number / Legal desaiption Record number Page number
�� a�-� 3-
Is the property used and occupied primarily for Assessed value of e property as of March 1, current year (may not
hisRiar residence?
Have you filed for any oiher deductions? If Yes, v+hat deduc6ons?
❑ Yes o
Have you Gled for deductlons in any other county? I( Yes, what wunry?
❑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 ot the aforementioned property on March 1, 20 _
Signature of appliwnt I Siqnature of authorized representative (by executed Power o7Attomey)
ress of applicant Address of authorized representalive
f /�/ �� /a�� �