Age_Friedmanal R���
= AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
3�� � � REQUESTING DEDUCTION FROM ASSESSED VALUATION
�' .� State Fortn 43708 (R6 / 4-04)
Prescribed by the Department of Local Govemment Finance
In rmalion contained in this document is CONFIDENTIAL pursuant to IC 6-1.7-12-9 and IC 6-1.135-9.
INSTRUCTIONS:
To be �led in person or by mail with the County Auditor of the county where
the propeRy is located.
See �everse side for additlonal instruction and qualifications.
COUNTY TOWNSHIP YEAR
F'le ar
FILING DATES: QPk 2 O ZOOE
1) Real property: During the 12 months 6e%re May
11 of the year th ucti�� 0 6e effective.
2) Mobile homes sse� un ed�.C.Ef-1-7;
between ,�16(dt16f7�pa1[�tp�ithe year
fhe deduction is to be effective.
Name o( applicant (owner or wntract buyer) �
Is applicant the sole legal or equitable owner? If No, what is his/her exact share or interest? If ovmed with someone other than spouse,
' indicate wiih whom
�Yes ❑ No
If name on record is diHerent than that oi applicant, indicate below
Name of contrad seller (applicant must have been buying on contract at leasf one (1) year)
Address of contraG seller Is the property in quesUon:
�Real property ❑ Mobile home (I.C. 67-1-�
Tazing distrid Key number / Legal description Rewrd number Page number
0 � -GO - C�
Is the property used and occupied primarity for
Have you filed for any other deductions? If Yes, what deductions?
❑Yes ❑No •
Have you filed for deductions in any oiher counry? If Yes, what counry?
❑ Yes ❑ No
INJe certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20
Signature of applicant � ISignature of authorized represeniative (byexecuted PowerolAttomeyJ
/ �
ress of applicant 6-Q K p• �a6 � d�� M� Address of authorized representative
O
Fa r f� r an �'� 7�. 5( 8�