Age_Carter��rt•n � AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
REQUESTING DEDUCTION FROM ASSESSED
'� � VALUATION State Form 43708 (1-90) Prescribed by the
°• �. State Board of Tax Commissioners
�
County � Township� Year
Instructions for filing: !� p ��-�' "--Fil�KAark
To be filed in person or by mail with the County Auditor of the County where the Mqy 1 1 1998
property is located during the 12 months before May 11 of the year the deduction
is to be effective. Deductions for mobile homes not assessed as real proper�ty� �
mustfile between January 15 and March 31. See reverse for additional instructiorfs , v`,�, �.
and qualifications. /. �� _.: ��:-.._-arr �,�.iorofi
Applicant wner or ontract buy,�r)�
,
v�;
Is applicant the sole le or If no, what is his/her exact share or If owned with someone other than
equitable owner? es O 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
�ng Di trict/� Ke Number/Le al D cription,_,�, Record No.
! � – -� ' .��d�` Page No.
Is the real property used an occupied primarily Assessed value of the property as of March 1, current
for his/her residence? es O no year (may not exceed $19,000).
Was th applicant 65 years of age or more on ApplicanYs date of birth �_��—�
Dece ber 31 of the year prior to the current year?
yes ❑ no If filed by a surviving, unmarried spouse, what was the
spouse's age at the time of death?
Does the combined annual adjusted gross Source of income =- Amount of income
income of the pplicant and any individuals S ._�
sharing own rship exceed $15,000?
O yes no
Total _
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
S�at� Authorized Representative (by executed Power of Attorney).
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Ad ress of Applicant Address of Representative
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