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e•°'°v AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
a � County Township Year
p� REQUESTING DEDUCTION FROM ASSESSED
° VALUATION State Form 43708 (1-90) Prescribed by the
-; �•�• `� State Board of Tax Commissioners
I�uctions for filing: e Mark
To be filed in person or by mail with the County Auditor of the County where the APR� 1 6 1993
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 prop
mustfilebetweenJanuarylSandMarch3l.Seereverseforadditionalinstruction AU� 0��
and qualifications.
Applicant (Owner or contra uyer
Is applicant the sole legal or no, what is his/her act share or If owned with someone other than
equitable owner? ❑ yes ❑ no interest? spouse, indicate with whom.
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
zexing District Key Number/Legal Descri tion Record No.
� — --Q= 3�=�Z_ Page No.
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?
IlVJe 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
Siqnat�,re Authorized Representative (by executed Power of Attorney)
.
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Add ss of Applicant Address of Representative
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