Age_Phillipsej rt'"v AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
�d ` RE�UESTING DEDUCTION FROM ASSESSED VALUATION
i' �
State Form 43708 (R /9-96)
�",.,—;- �'.��' Prescribed by tha State Boartl oi Tax Commissioners
Information contained in this document is CONFIDENTIAL pursuant to IC 6-7.1-12-9.
INSTRUCTIONS FOR FILING:
To be )iled in person or by mail with the County Auditor ol the county where the property is loca-
ted during the 72 months be%re May 7 7 0! the year the deduction is to be ellective.
Deductions !or mobile homes not assessed as �eal property must file 6enveen January 75 and
March 37.
See reverse side (or additional insfruction and qualilications.
Name of applicant (owne� o� contracf buyerJ
applicant ihe sole legal or equitable
is his/her exaci share of interest?
'S�,Ves ❑ No �
If name on record is diHerent ihan ihat of applicant, indicate below
�L�-G_X��n . �'Q ` \ c. n o .a , 4^i 'C
Name of contract seller (appli nt m( have en buyin9 on cvntract at leas( one
Address of con�ract seller
district
Key�rt}�er�egal desOcripyoq � O
(J � �-'1
hismer residence? �l '
�
Was the applicant 65 years of age or more on Decemb 3�
prior to the current yeaR
spoi
the e ot eath?
Have you filed for any other deduciions?
❑ Yes
Have you tiled for deductions in any other county?
❑ Yes
COUNTV TOWNSHIP YEAR
� ?'y` � `
M �
MAY 0 5 1999
G/Q� .. ._rOUi�TY�r/
° iesor�
wlth SOm00n0 Olh2r ihdn SPOUSB,
with whom
Assessea vaiue'ot tne pmpeny as oi March t, curreni year (may not
exceed 5'21,000)
❑No ❑Yes o
he year
I/We certity under penalty of perjury that the above and foregoing information is true and correct and that the applicani was a resi-
dent of Indiana and owner of the aforementioned property on March 1, 19
SignaWre of applicant SignaWre of authorized representative (by executed Power o/AttomeyJ
��r� �3and�Kd'
�
Address of