Age_Sharp.�*•n AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, COUNiv TOWNSHIP YEAR
a�,.`•44 REQUESTING DEDUCTION FROM ASSESSED VALUATION
State Fortn 43708 (R2/12-99)
�� � e� Prescnbed by ihe Sute Boartl of Ta< Commissioners
File Mark
Information contained in this document is CONFIDENTIAL pursuant to IC 6-7, 1-12-9. .
INSTRUCTIONS FOR FILING: ��� �
To be filed in person or by mail with the County Auditor of the county where the property is �
located during the 72 months before May 11 0( the year the deduction is to be effective.
Deductions for mobile homes not assessed as real property must file between January 15 and
Ma«n st. CT I 1?000
See reverse side fo� additional instiuction and qualilications. /% , � �
rvmne ui ayynwm �u� ne � cummci uuye�� �-�
C
Is applicant the sole legal or equitable owneR I If No, what is his/her exact
� Yes ❑ No
If name on record is diflerent than that of
or interest?
Name of contraci seller applicant must have been buying on contract at least one (t) year)
Address of coniract Iler
Taxin9 d' trict . Key m er / Le es n
� `y� ���� �����
Is the real property used and occupied
primarily for his/her residence?
�� tne appucant ti5 years ot age or more on
prior ro ihe curreni yeaR
! � � �
If filed by a surviving, unmarried spouse,
ai the time of deaih?
Have you filed for any other deductlons?
� ❑ No
December 31 of the
❑ Yes �t"No
�
�
was the spouse's age
❑ Yes lo
If owned wiih someone other than spouse,
indicate with whom
Record number '� Page number
Assessed value of the property as of March 1, current year (may not
exceed S23,000)
uoes tne combined annuai ad7ustea gross income c
any individuals sharing ownership ezceed 525,000?
Income
If Yes, what deductions
TOTAL I 5
❑ Yes ❑ No
Amount of Income
0 Yes F].FC6 I �
ANe certify under penalry of perjury that the above and foregoing information is true and correct and ihat the applicani was a resident
N Indiana and owner ot the aforementioned properry on March 1, 20
Signature of applicant Signature of authorized representative (by executed Power of Attomey)
of appliraN � ( Address of authorized representative .
°.ort 2