Age_Overtonej °"PO, AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
i:��' REQUESTING DEDUCTION FROM ASSESSED VALUATION
.
' State Porm 43708 (R / 9-96)
e„��� Prescribed by ihe State Board of Tas Commissioners
Information coniained in this document is CONFIDENTIAL pursuani to IC 6-7.1-12-9.
INSTRUCTIONS FOR FILING:
To be liled in peison or by mail with the County Auditor o1 the county where the property is loca-
ted during the 72 months belore May 77 01 the yea� the deduction is to be elfective.
Deductions lor mobile homes not assessed as real property must (ile between January 75 and
March 37.
See reverse side lor additional instruction and qualilications.
name on
contraci
Address of contract seller
COUNTY � TOWNSHIP VEAR
O�
File Mark
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r�a�r o 4 2000
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or conrra b er/ O
or eoui able owner? If No. whai is hisfner exaci share of interest? If ownei
es ❑ No
must have been buy/ng on contract at least one (1) year)
with someone other than spouse,
with whom
ig disirict Key number / Legal description Record number Page number
00%-007��- ��' _
a property used and occupied primarily for Assessed value ot ihe property as oi March 7, current year (maynot
er residence? exceed $27.000) �
es ❑ No ❑ Yes °�INo
ihe applicant 65 years of age or more on December 37 of the year poes the combined annual adjusted gross income of ihe applicant and any
to the wrrem yeaR individuals sharing ownership exceed 520,000?
etl by a surnvi
time of death?
�e you filed for
�e you filed for
�
unmarried spouse, what was
any
any
ne spouse s age at
❑ Yes o
❑ Yes ❑yco
�
I/We certify under penalty of perjury that the abovC and foregoing in(ormation is true and correct and that the applicant was a resi-
dem of Indiana and owner of the aforementioned property on March 1, 79 _
Signature of applicant
applicant
1I�
of authorized representative (by executed Power olAftomey)
of authorized representative