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AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, couNTV TOWNSHIP v�aa
REQUESTING DEDUCTION FROM ASSESSED VALUATION
�� S J State Form 43708 (R7 / 5-06)
w
Presmbed U/ the DeD��ent o1 Local Gwernmeni Firunce
Information contained in Ihis dowment is CONFIDENTIAL oursuant to IC 6-1.1-72-9 and IC 67.135-9.
FIUNG DATES: FEB G ���,�,�
1) Real property: D the 12 months 6efore �une
11 0/ the ear the ti�dd' to 6e eflective.
2J Mobile h�}ii�§�Y nd�.C.6-1-7-7;
between January 75 a��I�1�itfAQ�R7 ihe year
t6e deduction is to be effective.
INSTRUCTIONS:
To be �led in person or 6y mail with the County Auditor of the county where
fhe propeRy is located.
See reverse side (or additional instruction and qualifications.
applicant (owner w contrad buyer)
1 �
�nt the sole leg I or equitable owner?
If name on
contract seUer
Was the applicant 65 yea
prior to the wrrent year?
Applicant'S date of b'uth (
�-
on contrac[ at least one
Is the
;ey number / legal tlescription
a� �3-3y -���Qs�s -��.
If owned with someone
indicate with whom
in question:
spouse,
property ❑ Mobile home (I.C. 6-1-1-n
number Pavenumber
. Assessed value of the property as ot March 1, wrtent year (may rwf
- exceed $744,000)
es ❑No
. ber.37 of ihe year
)
❑Yes �o I
1
I/We certify under penalty of perjury ihat the above and foregoing infc+�**�����n is lrue and correct and that the applicant was a resident
of Indiana and owner of ihe aforementioned property on March 1, 20
, 'l
of authorized representaWe
of