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,,__, � AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, courm TOWNSHIP venrt
'� ` REQUESTING DEDUCTION FROM ASSESSED VALUATION
�> Sta[e Fortn 43708 (R6 / 4-04)
Prescri6ed by the Department of Local Govemment Finance
�nafion contained in this document is CONFIDENTIAL pursuant to IC 6-1.7-72-9 and IC 6-1.1-359.
INSTRUCTIONS: FILING DATE D E C 1 3 ZOO4
To be filed in person or by mail with the County Auditor of the county where 1) Rea perty: Du ' g the 12 mo hs fore May
the property is located. 11 o e r i i ffective.
2) il��cK_f������ ri is-�-�-�;
See reverse side for additional instruction and qualifications. 6ehveen January 15 and March 31 of the year
the deduction is to be ef/ective.
or
or
If No, what is hislher exact share or interest?
(�'es ❑ No �
name on record is diRerent than that of applicanl, indicate below
�
ofcontract
districl
property used a(tf occupied primarily for
r residence?
the applicant 65 years ot age or more on
to the current year?
iliwnPS
— �
ed by surriving, unmarzied spouse, u
time of death?
you filed for any oiher deductions?
you filed for deduUions in any other
vy/ng on contract a� �east one
Key number / Legal descrip6c
�D��oa � s
a
ex
es ❑ No
�ber 37 0( the year
I/We certify under penalty of perjury lhat lhe above and foregoing information is true and correct and lhat the applicant was a resideN
of Indiana and owner of the aforemeniioned property on March 1, 20
oi
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