Age_Lindauer„� , .
AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, couNrr TOWNSHIP r�
REQUESTING DEDUCTION FROM ASSESSED VALUATION
S�� / Slate Fmn 43708 (R7 / 506)
P`esmLed Dy the Departmrst of Lacai Gwemment Finance
I f�C
alion contained in this document is CONFIDENTIAL Dursuant to IC 6-1.1-12-9 and IC 6-1.1-35-9.
INSTRUCTIONS: FILING DATE 7 (�7
To be filed in person or 6y mail v+ith the County Auditor o( the county where 1) Real property Dun'ng t�i �i2 months before June
the property is located. 17 0/ the y�e de c n is to be effective.
2) Mo6i/e ho es a der I.C.6-1-1-7;
See reverse side (or additional instruction and quali�cations. be����Y1Po�1��� �3l of the year
the deduction is to be e ective.
(
owner! I tt No, what is
❑Yes ❑No
name on record is differenl than that of applinn
or �o-aa
must have been buying on contract
mperty used and ocwpied primarily for
residence?
exact share a
one (1) year)
owned vriih someone other than spouse,
dinte with whom
Is the property in question: -
/�f2eal property ❑ Mobile home Q.C. 6-7-1-n
Record number Page number
�-f4 _ ao.a.o�o -a�o. �ld
�Yes ❑No
; ihe applicant 65 years of age w more on December�31 of the year
r to Ihe current year?
�s ❑No
dkanCs
��
fw any other
❑No
you filed for deduc0ons in any other
Pssessed value ot ihe property as of March 1, arrent year (may'ai
ezceed $144.000)
sharing uwnership exceed 525,000?
It Yes, what
Ii Yes, whal
any
❑Yes ❑No
❑Yes ❑No I
I/We certity under penalty of perjury ihat the above and toregoing info��+��n is true and cortect and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20
Signa[ure of authorized representative (by ezecuted Power olAttomey)
/aS9� ��e
.::
�
representative