Age_Maier.K„
AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, counrr TOWNSHIP r�
REQUESTING DEDUCTION FROM ASSESSED VALUATION
� � Sfate Fortn 43708 (R7/ 5-06)
Presmbed by the Deparlmrnl ot Laal Gwanment Finarcx
� �Mark
�ation contained in this document is CONFIDENTIAL Dursuant to IC 6-1J-12-9 and IC 6-1.1- g gq
INSTRUCrIONS: F ING�9A➢ESY
To be (led in person or by mail with the County Auditor of the county where 1) Real property: Dun��Q, the 12 months before �une
the property is located. �� o
�Qa'y�r9h��@uction is to be effeciive.
2) Mobile homes assessed under LG6-1-1-7;
See reverse side for additional instruction and qualifications. betwe�y�Janu� � nd Ma�ch 37 of the year
the d�duc� is to eflg tive.
IBSON COUN7Y AUDITO�
Name of applicant (owner w conbact Wrye�n . .
Is applipnt the sole leg
If name on record is ditf
Name of contrad seller
or equitable owneR It No, what is
❑Yes ❑No
ent than Mat of apolicant, indicate below
exacl share or
musi have been buyinq on contrad at least one
ss of contrad seller
� district Key number / Legal d�
�Q a6- �3- y-�co-o�oo.
W�DertY used and ocapied P�marily for �
r residence? -
Was the applicant 65 years o
prior to Ihe wrre�t year?
ApplicanYs
the time of dea�h?
YW
you
❑Yes ❑No
age or more on December.-37 of the year
[]Yes ❑No
xas ihe spouse's age at
any other deductions?
�Yes ❑No
deductions in any othef county?
❑Yes ❑No
���, witli someone other than spouse,
with whom
Is the property
❑ Real property � Mobile home Q.G G7-1-�
Record number Page number
�6-oob I I
Assessed value of Ihe property as of March 7, wrtent year (may rrot
ezceed 5144,000)
$
I/We cerlify under penalty of perjury ihat [he above and toregoing info•**�����n is true and correct and ihal the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20
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�
0 A„�,
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representabve (by executed
representative