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� AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
REQUESTING DEDUCTION FROM ASSESSED VALUATION
�' y�• � State Form aJ708 (RS / 6O3)
FiewiEed Oy Iha Deparimeni of local Gwemment Finance
Infortnation contained in this document is CONFIDENTIAL pursuant to IC 6-1.7-72-9.
�STRUCTIONS:
COUNTY � TOWNSNIP
File Mark
YEAR
To be (led in person or by mail wifh the County Auditor o/ (he count where FILING DATES:
the property is located. y 1) Real pioperty: During the 72 months be(we May
' �-• 11 ofthe yea�fhe ded t'
See reverse side lor additional instruction and qualifications.
.. — •�I ",.,.......,,�o,� - `►—•
� applicant the sole lepal equitaDle owner/ If No, wt
�j] Yes ❑ No
name on record is difterent th�dn that of applicaN, indicate 6
ame of wnVact seller ( plrcant musf have been buying on
A
exact share or
at leasf one
uc �on is ro 6e eHechve.
2) Mobile homes assessed under I. C. & 1-1-7;
between January 15 and March 37 olthe year
the deduction is fo 6e eHective.
owned wit}i some
d�ica`te vriN whom
l� /
GI �,��/Y
spousa,
Is the property in question:
❑ Real property ❑ Mobile home (I.C. 6-1-1-�
number / Legal dascription Record number Page number
es ❑ No
Was the applicani 65 years of age or more on Dec ber 31 of the year
prior to Ue avent year9
�Yes ❑No
mcanrs aate ot
ed by a surnv�ng, unmamed spouse, what was Ihe spouse's age
ume of deaN7
Have you filed for any
❑ Yes
you filed for deducUons in any other wunty?
nssessetl value of Ne property as of
exceed 5744,000)
I If Yes,
combined annual ac
s sharing ownership
what
current year (may not
d the appliwnt and any
❑ Yes ❑ No
Amount of Income
-�
� nn■
L7 Yes �.No I
_ �
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
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