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, AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
REQUESTING DEDUCTION FROM ASSESSED VALUATION
� � State Form 43708 (RS / 603)
/M�
Presaibetl by Ne Department of Local Govemrtrent Flnance
InformaGon contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12•9.
COUNTY I TOWNSHIP I YEAR
y L iJ �J ��
UCTIONS: FILING DATES:
To 6e filed in person or by mail with [he County Auditor of the counry where 1) Real property: Du� tri�e 121ma�'�before May
the property is Ixated. 11 of the ear the deduction is [0 6e effective
See reverse side fo� additional instiuction and qualificafions.
Name of appliwnt (owner or cont2U buye� ,
� (
exaa share or int
�/ es ❑ No
If name on record is different than that of applicant, indicate below
Name of conVact seller (applicant must have been buying on contract at least one (1) year)
property use
r residence?
the applicant 65 years of age or more on
to the arrent year?
If filetl by a surnhi
Ne tlme of death?
(
�
imartied spouse, what was
you filed for any oiher
❑Yes ❑No
mber 31 of the year
es ❑ No
age
❑ Yes ❑ No
you filed for deductions in any other county?
s�aa,000)
2) Mobile homes assessed'undei I.C.6-}� 1-7;�
between January.l5 and March 31�of th�—e(��year
the deduction is'.to�be'.e8ective:.UDi7pR I
i vnm someone otner man spouse,
wiN whom
Is the property in quesiion:
❑ Real property ❑ Mobile home (I.C. 6-1-7-�
as
year
�
❑ 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 aforementioned property on March 1, 20 _
gnature of applicant ^ _ Signature of authorized representative (by executed Power olAttomey)
of epplicant ' Address of authorized representative
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