Age_Jenkins��
j AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
REQUESTING DEDUCTION FROM ASSESSED VALUATION
� � State Fortn 43708 (RS / 6-03)
Prescribed by ihe Departrnent ol Laal Govemment Finance �
O
In� ation contained in lhis document is CONFIDENTIAL pursuanl to IC 6-1.1-12-9. ��
/
COUNTY TOWNSHIP YEAR
File Mark
RUCTIONS: M FlLING DATES:
To 6e filed in person or 6y mail with the County Auditor of the counry where 1) Real property: During the 12 months be(ore May
the property is located. 11 of the year the deduction is fo be effective.
2) Mobile homes assessed under I.C.6-1-1-7;
See reverse side /or additional insfruction and qualifications. 6etween January 15 and Maroh 37 of the year
the deduction is to be eNective.
of appliwnt (owner
or
nameon
❑Yes ❑No
No.
�
or
Name of contract seller (applicant must have been buying on contrect at least one (1) }rearJ
�er residence?
VJas the applicant 65 years ot age or more on
prior to the curtenl year?
ApplicanYs
was the spouse's age at
❑ Yes ❑ No
$ �,
❑ Yes f�'No �
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 _
gnature�[pppliwnl Signature of authorized represeniative (6y executed Power o/Attomey)
4 �G`��1
Address of authorized
S