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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
��cing District Key Number/Legal Description Record No. �
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Is the real property used and occupied primarily Assessed value of the property as of March 1, current
for his/her residence? �s O no year (may not exceed $19,000).
Was the applicant 65 years of age or more on
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 penaliy of perjury that the above and foregoing information is true and correct and that the appli-
canf was a resident of Indiana and owner of the aforementioned property on March 1, 19
Si�qnature Authorized Representative (by executed Power of Attorney)
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ddress of Applica Address of Representative �
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