Age_Colemant AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, cour+TV TOWNSHIP rena
REQUESTING DEDUCTION FROM ASSESSED VALUATION
S�/ Slate Form 43708 (R7 / 5-06)
�' Pmsznbed by Ne Deparunmt W Lod Goverrmeni Finance
File Mark
Information confained in Ihis dowment is CONFIDENTIAL pursuant to IC Fr1.1-12-9 and IC 6-'1.1-35-9� � g ��""�
q �j �
INSTRUCrIONS: FILI DA �e % �L�
To be filed in person or by mail with the County Auditor oI the counry where 1) Real property: During the 12 months 6efore June
the property is located. 11 of th� ee�r 1h�d�BJ{pjion is to be eNective.
2) Mo6ile homes assessed under I.C.6-1-1-7;
See reverse side for additional insiruction and qualifications. betwe uary ,�^�d March 31 of the year
the ded ct � �f�,affective.
name on
6uyerJ
�u'itable owne(? If No, what
Yes ❑No
ian that al applicant. indinte bel�
Narne oi conVac[ seller (applica t mus
� �
Address of contract selier
buying on contracl a[ least one
ab-i�-o6-
Was the applicant 65 years of age or more on December9l of Uie year
prior to ihe current year? .
❑Yes ❑No
AppficanPs date oi b"uth (month, day, yea�
� - ��-
If filed by a surviving, unmartied spcwse, what was tFie spouse's age at
the Ume of death? - `. ..
Have }rou filed fw any
❑Yes
you filed for deductions in any
o� interest? If owned wiM someone other Nan spouse,
indicate with whom
Is ihe properry in ques�
�ieal property
00 -c�. d�7-o�
:ed value of the property as
Yes, whal
-_
❑Yes {�No �
IlWe certify under penally of perjury that the above and foregoing info�=}��n is Irue and correct and that �he applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
authorized
Address of authorized