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AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, couNrr TOWNSHIP vEna
REQUESTING DEDUCTION FROM ASSESSED VALUATION
�• �w � S�ate Form 43708 (R7 / 5-08)
Prescnbed by tt�e DeparOnent of Loml Govemmeni Finanfx
� �FI�Bi1�af{S-.
�rmation contained in this document is CONFIDENTIAL pursuant to IC E1.1-72-9 and IC 61.1-35-9. q'
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INSTRUC710NS: FILING DATES:
To be filed in person or by mail with the County Auditor o! the county where 1) Real property.{f�ri�gRh� 1%2�}n�ths 6efore �une
the p�operty is located. 11 of the year the deduction is to be eflective.
2) Mo6ile homes ed I.C.6-1-1-7;
See reverse side for additional instruction and qualifications. between Janu ry' S�'id Ma 31 0( the year
the dedi.@t�84�ftS.�JJ4li�tA4iAITOR
(owner or contrad
apptirant the sole legal or
❑Yes
name o� recoid is difterenl than ihat
the property uSe
;lher residence?
must have been
primarily for
the applicant 65 years of age a more on
to the wrrent year?�
It No, what
licanPs date oi b'vth (month, day, yea�)
�
� by a survrving, unmarried spouse, what was ihe
Gme of death?
Have you
any
Have you filed for deducUOns in any other county?
m
.�T�
one (7} year)
number / Legal description
'v-/�-13���-b00
❑ No
of the year
❑No
age
❑ No
If owned with someone other than spouse,
i�icate with whom
property in question: �
❑ Real property � Mobile home (I.C. E1-1-�
Remrd number Page �umber
property as of March 1, wrtent year
iT�;
❑Yes �1Jo I
IlWe certify under penalty of perjury that the above and foregoing info�=+��n is true and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
�nature of appticant Signature of authorized representaWe (by execufed Power o7Attomey)
�� � w-. Ch !ur �YL( (��`-�""T"1 .— -
r:ress ot applicarR
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