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3. !: , AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
� REQUESTING DEDUCTION FROM ASSESSED VALUATION
t �� SUte Fortn 43708 (R4 / 10-01)
Prescribed by Ne Depanment of Local Govemment Finance
Intortnafion contained in this dowment is CONFIDENTIAL pursuant to IC 6-1.1-12-9.
INSTRUCTIONS:
To be filed in pe�son or by mail with the County Auditor of the county where
the p�operty is located.
See reverse srde for additional inst�uction and qualifications.
of applicaryt�(owner or contract buyer)
or
No, whtlis hishier exad share or interest?
[�CCes ❑ No I
name on record is diRerent ihan lhat of applicant, indicate below
the
of con Iler (a
�s of co t ad selier
and occupied primarily (or
me appucani tis years oi age or more on
to the cuvent year?
If fJed by a surviving, unmarried spouse, what was Ne spouse's age at
Ihe time of death?
Have you filed for any other deductions?
❑ Yes �No
Have you (led for deductions in any other county?
❑ Yes
COUNTY TOWNSHIP YEAR,
File Mark
FILING DATES:
1) Real properly: During the 12 montF,s 6efo�e May
11 of the year fhe deduction is to be effective.
2) Mobile homes as.�ss,e n rl.C.6-1-1J;
�pNreE�J�uary g5.an a 37 oI the year
Assessed value of the
exceed $69,000)
�p.k 1 ��
spouse,
G�gSON
property in question:
�,Real pmperty ❑ Mobile home (I.C. 614-�
Record number Page number
as of March 1, current year
IIVJe certify under penalty of perjury thal the above and foregoing infortnation is true and correct and that the applicant was a resi-
dent of Indiana and owner of the aforemenlioned property on March 1, 20
aNre of applicant Signature ot authorized representafive (by executed Power olABomeyJ
�plicant ' � IAddress of aulhorized representative
O�/�' .3 �_��.r.��•., /e%lf7l�ra