Age_Osbornemn
� AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, couNTr TOWNSHIP venR
REQUESTING DEDUCTION FROM ASSESSED VALUATION
S W� � State Fortn 43708 (RS / 603�
� P25cnbetl by ihe Depariment of Local Govemment Finance
File Mark
Intortnation contained in this document is CONFIDENTIAL pursuant to IC E1 J-12-9.
�RUCTIONS: FI �NG��� y
To be filed in person or by mail with the County Auditor of the county where 1 Rea e n��s before Ma
the propeRy is located. 11 o e y r t e deducfiQ��(s to be eHeciive.
2) Mobile hor¢�S�ss�S�eaiHi�er I.C.6-1-1-7;
See reverse side for additional instruction and qualifications. 6etween Jafi`uary 15 and� March 31 o�j the year
the de�uction is rope �f/ryctive/� �/
Is annlicant the sde leaal or eauitable owneR
name on
contrect
Addreu of
residence?
� No
must
and occupied primarily for
was tne applicant 65 years ot age or more on uece
prior ro the curtent year?
AppficanYs date of birth (month, day, year)
�-
�
I/We certify under penalty of perjury that the above and foregoing information is true and conect and that the applicant was a resident
of Indiana and owner of the aforementioned property on March t, 20 _ '
�3