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�"="•a /1FFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
a t RE�UESTING DEDUCTION FROM ASSESSED VALUATION
l�, �� Staze Form a3708 (R / 9-96)
�" �, Prescribed Dy the Su;e Boartl ol Ta. Commissioners
Information coniained in Ihis documem is CONFIDENTIAL pursuant to IC 6-7.1-12-9.
INSTRUCTIONS FOR FILING:
To be Iiled in person or by mail with the County Auditor ol the counry where the property is loca-
ted during the 12 months belore May 71 0/ the year the deduction is ro be el(ective.
Deductions for mobile homes not assessed as real property must file beriveen January 15 and
March 37.
See ieverse side for additional instruction and qualilications.
COUNTY TOWNSHIP YEAR
File Mark
11 ' �.._
FE� 1 � 1999
�l&S0� Ou, TY F�0'TC4�
Name of applicant (owner
his/her e ci share of i erest? If owned with someone other ihan spouse,
indiCate with whom
S ❑ NO
It name on record is differeni Iha that of applicant, indicate below
Name of contrad seller (applicanf must have been buying on crontracf at least one (7) year)
Address of contract seller
�xing district Key number / Legal description Rewrd number Page number
� �s�t ,
Is the property used and occupied primarily for Assessed value of the property as of March t, current year (maynot
his/her residence? exceed 321,000)
es ❑ No ❑ Yes ❑ No
Was the applicaN 65 years of age or more on December 3t of the year poes the combined annual adjusted gross income of the applicant and any
prior to the curreni year? individuals sharing ownership exceed 520.000?
❑Yes ❑No
Applican�'s date of birth (month, day, year Source of Income Amount of Income
, -
s age at $ ^
the time of death?
TOTAL S --
Have you tiled for any other deductions? If Yes, what deductions?
es ❑ No
Have you filed for deduciions in any other county? It Ves, what county?
❑ Yes o
I/VJe certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant was a resi-
dent of Indiana and owner of the aforementioned property on March 1, 19 <�
ISignature of applicani SignaNre of authorized represen[ative (by execufed Power ol AttomeyJ
C
ess of applicant Address of authorized representative
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