Age_Tichenor,�•"-°o AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
•° �t, REQUESTING DEDUCTION FROM ASSESSED.
VALUATION State.Form 43708 (1-90) Prescribed by the
°• ' State 8oard•of Tax Commissioners �
,
Instructions for filing:
To be filed in person or by mail with the County Auditor of the County where the
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 property
mustfile betweenJanuary 15and March 31. See reverse foradditional instructions
and qualificatioris.
County Township Year
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�[�AY 1019g5
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AUDITOR
App/licant (Owner or contract buyer)
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Is applicant the sole legal or If no, what is his/her exact share or If owned with someone other than
equitable owner? �s O no interest? spouse, indicate with whorri.
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 District K�eY Number/Legal Description Record No.
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Is the real property used and ccupied primarily Assessed value of the property as of March 1, current
for his/her residence? � es rJ no year (may not exceed $19,000). �3 U
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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 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 9 sl
S�nature Authorized Representative (by executed Power of Attorney);
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Address�" Applicant � Address of Representative
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