Age_Overfield�
AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, couNTV TOWNSHIP v�
i REQUESTING DEDUCTION FROM ASSESSED VALUATION
S � State Fortn 43708 (R7 / 5-06) .
��w
Pnesmbed by the Departmenl o( Local Govemment Finance
I
information wntained in lhis dowmeni is CONFIDENTIAL pursuant to IC 6-�.1-72-9 and IC 67J-35-9.
INSTRUCTIONS:
To 6e filed in person or 6y mail with the County Auditor o! the county where
the property is located.
See reverse side (or additional instruction and qualifications.
Name ot applicant (owner or ca ct buyer) �
C •6 � r J
Is applicant the sole legal or equitable awneR If N at is+hisTh euact share w
❑Yes ❑No
If name on remrd is different than Nat �
Name of contract seller (appllcant must
Address of conGact seller
ocCUpied primarily for
residence?
Me appl�cant tiS years ot age a mae on
to ihe wrrent year?
indinte 6elow
on contract at least one
�-d6U��d'� -OoZlo
AppticanPs
tt filed by a surviving, unmarried spouse, what was the spw
the Ume of death?
Have you filed for arry olher deducCOns?
❑Yes
Have you fiied for deductions in any other county?
❑ No
the year
❑No
age at
FILING DA7� 1 j Z00%
1) Real property: During the 12 months 6efore �une
11 of th�� r the� c ion is to be eflective.
2) Mobilefi"orri�ssess�underl.C.6-1-7=7;
bgp�ppl�081�tTf6 &WDI�H�@h 31 of the year
the deduction is to be effective.
I with someone
with whom
Is ihe propeAy in
"'3��
property � Mobile home (I.C. 6-1-1-�
number : Pagenumber
�
❑Yes �Jo �
I/We certify under penalry of perjury tha[ the above and foregoing info�**+����n is [rue and correct and that the applicant was a resident
of Indiana and owner of [he aforementioned property on March 1, 20 _
representaWe (by executed
representaWe