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3 2 AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
�� ` REQUESTING DEDUCTION FROM ASSESSED VALUATION
� �q � State Fortn 43708 (RO / 7P41 �
Prescribed Dy the Depanmenl of Local Govemment Finance
�malion conlained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9.
INS7RUCTIONS:
To be filed in person or by mail wifh the County Auditor o/ the county where
the p�operty is located.
See 2verse side /or additional instrucfion and qualifications.
COUNTY � TOWNSHIP � YEAR
FILING DATES: ❑n'
1) Real pre�oai�y: �unb�VN� 12 months before May
l f�a! the year the deducfion is to be e8ective.
2) �bile han �Slassessed u der�C.6-1-1-7;
beKveerJanuary�t5�R((`M��ch 31 of the year
�the d'eiluction is'to beqehecCi've. �
Name of ap ' t(owne� or contracf buye
� — _ �
Is applicant the sole legal or equRa le r? If No, wh ' � ex share or interesl? If owned wiih someone other than spouse,
� indicate with whom
❑ Yes ❑ No
I( name on record is diRerent than that of applicant, indiwte below
Name of contrad seller (epplicant must have beon buying on contract at least one (7) year)
Address o( wntrad seller Is the ro e
p p rty � . question:
eal property ❑ Mobile home (I.C. 61-1-�
Ta�dng districl Key number I Legal description Record number Page number
� 4--��VO `—�—'�
Is Uie praperty used and occupied primarily for Assessed vaiue of the property as of March 1, wrrent year (may not
hisRier residence? ezceed 869,000)
❑ Yes ❑ No
Was the applicant 65 years of age or more on December 37 of the year
$
Have you fied for any olher deductions? If Yes, what deduclions?
❑Yes ❑No
Have you filed for deductions in any other county? If Yes, what county?
❑ Yes ❑ No
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the applicanl was a resi-
dent of Indiana and owner of the aforementionad property on March 1, 20 _
Signa e of applicant SignaNre of aulhorized represenlative (by executed Power o/Attomey)
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,s of appiica Address of authorized representative
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