Age_Selby..�'l
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� AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
'� � � REQUESTING DEDUCTION FROM ASSESSED VALUATION
>�_�i State Fartn 43708 (R6 / 4-0a)
Prescribed by ihe Department of Local Govemment Finance
�nation contained in Ihis document is CONFIDENTIAL pursuant to IC 6-1.1-72-9 and IC 6-1.1359.
INSTRUCTIONS:
To be filed in person or 6y mail with the County Auditor of the county where
the property is located.
See reverse side (or additional instruction and qualifications.
COUNTY TOWNSHIP YEAR
I �
MAR 1 7F�e�p��k
FILING DATES�
1) Rea/ proper�Bring �iE�3unonths be%re May
11 of ��4t����d�6�O���tQ b�e effective.
2J Mo6ile homes assessed un erY. .6-1-1-7;
behveen January 15 and March 31 ot the year
the deduction is to be effective.
Name of applicanl owner or contract b e�) �
Is applicant the sole legal or e able owner? If No at is hislher exact share or interest? If owned with someone other than spouse,
' indicate with whom
Yes ❑ No
If name on rewrd is diRerent than Nat of appliwnt, indicate below
Name of contrad seller (applicant must have been buying on contract at least one (i) year)
Address of conUact seller Is the property in question:
Real property ❑ Mobile home p.C. E7-1-�
Tazing di 'ct Key number / Legal descripiion Record number Page number
� Oo� Di�9a -�
Is th property d and occ i d primarity for Assessed value of the property as of March 7, current year (may not
hi er reside � exceed 3144,000)
Yes ❑ No
Was the applirant 65 years of age or more on December 31 of ihe year
$ � , �
Have you filed for any other deductions? If Yes, what deductions?
�%C� . � Yes ❑ No
Have you filed tor deductions' any oiher coun If Yes, what county7
❑Yes ❑No •
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant was a resident
of Indiana and owner of the aforemenlioned property on March 1, 20
Signature of applicant Signature of authorized representative (by executed Power o7Attomey)
ess of applicant Address of authorized representative
t� 6 � �