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t AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
� REQUESTING DEDUCTION FROM ASSESSED VALUATION
�� / SWte Fortn 43708 (R6 / 4-0a) ,
Prescribed by ihe Depanment of Local Govemment Finance
Irilbrmatlon contained in this document is CONFIDENTIAL pursuant to IC 6-1.7-12-9 and IC 6-1.1-359.
INSTRUCTIONS:
To 6e filed in person or by mail with fhe CountyAuditor o( the county where
the property is located.
See reverse side !or additional instiuction and qualifications.
� applicant the sole legal or equitable �
p Yes
name on record is diBerent fhan that
of contrad s�ller (applirant must have been
_ `�L.
exact
on contract at
number / Legal descriptlon
❑Yes ❑No
the applicant 65 years of age or more on December 37 of ihe year
to the current year?
❑ Yes ❑ No
— � �
i a surviving, unmarried spouse, what was the spouse's age
of death?
you filetl for any
you filed for ded
in any oiher county?
❑ Yes
❑ Yes
or
COUNTY TOWNSHIP YEAR
File Mark
F 1J Re prop�ty: ur'n ��l�hs before May
11 o he year the deduction is to be ef(ective.
2) 6etween�.�7i i�ry 15ah1! 14fa ch 31 of the year
the deduction is to 6e effective.
someone
whom
Is ihe property in question:
spouse,
❑ Real property O Mobile home (I.C. Gt-1-�
Rewrd number Page number
S � CJLJ I I
Pssessed value of the property as of March 1, current year (may not
exceed $f44,000)
1/We certify under penalty of perjury that the above and foregoing information is true and correcl and that the applicant was a resident
of Indiana and owner of the aforemenlioned property on March 1, 20
of applicant
�
Address of authorized representative