Age_Georges:�
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AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, ro i r�
REQUESTING DEDUCTION FROM ASSESSED VALUATION ��
. S�! State Form 43708 (R7 / SOB)
presrnbed by the Departrnenl of Lod Gwertiment Finance
le ark
�alion wniained in this document is CONFIDENTIAL pursuani to IC 6-1 J-12-9 and IC 6-1.1-35-9.
INSTRUCTIONS: FILING DATES: '6
To be filed in person or by mail with the Counry Auditor of the county where 1) Real pro�gC(W�@Yp k7T� 4efore June
Ihe property is located. 11 of the year the deduction is to be eflective.
2J Mobi/e homes assessed under I.C.6-1-1-7;
See �everse side !or additional instruction and qualifications. between January 15 and March 31 of the year
the deduction is to 6e eRective.
' \
name on
Name oi contraG
P�PenY �
r residence?
(owner w oonVact dryerJ �
� �
e legal or equitabie owneR Ii No, what is his
❑Yes ❑No
s different than Nat of applipnt, indicate below
buying on conbact af least one
seller
w interesCY If owned vrith someone oNer Nan spouse,
irMicate with whom
Is ihe property in quesUon:
❑ Real property ❑ Mobile home Q.C. E14-n
Record number Paae number
►�„c�/ � a� -�8- �3 - yoY-ooa �-Y3 -oa-�lO
�w� p����y (� . Assessed value of the property as
Was the applicant 65 years of age w more on
priw to the arrent year?
Applicant's date of
�
If filed by a surviving, unmartied spouse, what
the time of dea�h?
Have you fited Por any other deducfims?
Have you filed for deductions in any other cou
year
❑No
was the spouse's age at
❑Yes ❑ No
Yes, what
c
❑Yes ❑No I
1/We cerGiy under penalty of perjury that the above and foregoing info�**+�r��n is We and correct and that the applicant was a resident
of Indiana and owner of lhe aforementioned property on March 1, 20 _
Ow� , �(/
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representative (byexecufed
representative