Age_Wall�" t AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
- ; REQUESTING DEDUCTION FROM ASSESSED VALUATION
S � State Form a3708 (R3 / 8-00)
'•'• Prescribed by the State Board of Taz Commissioners
Inrormation contained in this dowment is CONFIDENTIAL pursuant to IC G7.1-12-9.
COUNN TOWNSHIP YEAR
File Mark
INSTRUCTIONS FOR FILING: � � � � �
To 6e filed in person or by mail with the County Auditor ol the county where the property is loca-
ted during the 12 months before May 11 of the year the deduction is to 6e effective.
Deductions (or mobife homes not assessed as real property must file 6etween January 15 and
Ma�ch 31. • • •
See reverse side for additional instruc6on and aualifica6ons.
ame of applipnt (o n ro
appiipnt the so e legal or
name on record is diBerert
of conUad seller
owneR � If No,
Yes ❑ No
the applicant 65 years of age or more on
lo the wrrenl yea(t
ApplicanCs date of birth (month, day, yeah
/�—��
I( filed by a surviving, unmarried spouse, what was
the 6me of death?
you filetl for any
you filed for dedudions in any other
hisRier exad share or
on contract at least one (7J yearJ
umber / Legal description
Auessed value i
exceed 569, 000)
�S ❑ No
31 of the year
❑ No
age at
,.
Yes ❑ No
❑ Yes
MAY 12 2003
If owned with someone other than spouse,
indicate with whom
property as of March i, curtent year (may nof
Does the combined annual adjusted gross income
individuals sharing ownership exceed 525,0007
I/We certify under penalty of perjury that fhe above and foregoing information is We and corred and that the applicant was a resi-
denl of Indiana and owner of the aforementioned property on March 1, 20 _
appiipnt
�1 �Gt��
Address of authorized representative