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AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
REQUESTING DEDUCTION FROM ASSESSED County Township Year
VALUATION State Form 43708 (1-90) Prescribed by the
State Board of Tax Commissioners ��� �
Instructions for filing: �Y �$}y�jle Mark
To be filed in person or by mail with the County Auditor of the County where the
property is located during the 12 months before May 11 of the year the deduct�� . /
is to be effective. Deductions for mobile homes not assessed as real ro �t .,,.�-�•�- ��
mustfile betweenJanuary 15 and March 31. See reverseforadditional instrucPons -��'��' e���!'r� Y AUGITCR
and qualifications.
Applic (Ow r r contract buy -
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Is applicant a r - If no, what is his/her exact share or If owned with someone other than
equitable o er. s❑ no interest? spouse, indicate with whom.
If name on record is different than that of applicant, indicate below:
Name of contract seller (Applicant must have been buying on contract at least one (1) year.)
Address of contract seller
' g Di trict Key Nu ber/Legal D scr ti /J-� n Record No.
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Is t e real property used and occupied primarily Assessed value of the property as of March 1, current
fo is/her residence? ❑ yes O no year (may not exceed $19,000).
Was the licant 65 years of age or more on
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Have you filed for any other deductions? If yes, what deductions?
Have you filed for any deductions in any other county? If yes, what county?
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the appli-
cant was a resident of Indiana and owner of the aforementioned property on March 1, 19
Si�r�r�� Authorized Representative (by executed Power of Attorney)
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Address of Applicant Address of RepresentatiVe
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