Age_Grayn.r� �
rr�_, .� AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
REQUESTING DEDUCTION FROM ASSESSED VALUATION
�'+ ,��� � SWte Fortn 43708 (R6 / tAa) �
Prescribed by Ihe Depanment of Lowl Govemment Finance
ortnation contained in this dowment is CONFIDENTIAL pursuant to 6-1.7-12-9 and 6-�. 359.
INSTRUCTIONS: FILING
To be filed in person or by mail with the CountyAudito� of the t where 1) R 1 property: �'� �e�2�iQ�r�ths 6efore May
the p�opeRy is located. �/ 1 0! the year the deduction is to be eKective.
2 obile homes assessed r 1.C.6-1-i-7;
See reverse side lor addilional instruction and qualifications. ��'een Janua�7�5` arc�P 31 of the year
the deducG�oBnSjs��o 6�A�fpo�iydlDITOR
name on
of
� 1 �
No, iat is his r exact
Yes O No
that of applicant, Indicate below
must have been buying on contract at least o
Was Ihe applicant 65 years of age or more on
prior to the current year7
filed by a
e time of
you
you
date of birth (
surviving, unmarried spouse, wha�
jeath?
led for any other deductions?
led for deductions in any other co�
or
year)
� wifh someone other than spouse,
with whom
❑ Real property ❑ Mobile home (I.C. 6-1-7-�
� �'/3��/o%a�. o � c�
$
I/We 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 _
oi
� X�� /
y
representative
o( authorized representative
executed Power oJAttomeyJ