Age_Kisselaj �''o AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, courirv TOWNSHIP VEAR
` � REQUESTING DEDUCTION FROM ASSESSED VALUATION
��• State Form 43708 (R / 9-96)
"�• PrescnbeC by the State Board ol Tax Commissioners
Information wntained in ihis document is CONFIDENTIAL pursuant to IC 6-t.1-12-9. FilO Mark
INSTRUCTIONS FOR FILING: �� � i� � �
To be liled in person or by mail with the County Auditor of the counry where the property is Fpca- r..i .c;,_,' ,
ted during t6e 72 months be%re May 77 of the year the deduction is ro be ellective.
Deductions lor mobile homes not assessed as real property must lile between January 75 an�qpR G j 2000
March 37.
See reverse side for additional instruction and qualilications. � � � �
ame o�Ga{ic nt (owner or contra buye�)
� � �
applicant the sole legal or equitable owner?
❑ Yes ❑ No
name on record is dittereni than [hat of applicant,
must have been
Is the p
his/her
l
Was ihe applicant 65 years of age or more on
prior ro ihe current year?
pplicanYs date
p Yes ❑ No �
I/VJe certify under penalty of perjury that the above and foregoing information is true and correct and that ihe applicant was a resi-
dent of indiana and owner of the aforementioned property on March 1, 19
a+ure nt aoolirant I Sianature of authorized reoreseniative !bv executed Power ofAnornev)
lress of applicani
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