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° � AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
'�r` ` REQUESTING DEDUCTION FROM ASSESSED VALUATION
�> .° Sute Form 43708 (R6 / 4-Oa)
Prescnbed by the Oepanment ol Local Govemment Pinance
�mation contained in ihis document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6-1.1-35-9.
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COUNTY TOWNSHIP YEAR
File Mark
INSTRUCTIONS: �� AT��
To be filed in person or 6y mail with the CountyAuditor of the county where 1) e pro y. D ng e 12 months be(ore May
the p�operty is located. ction is fo be eHective.
2) Mobile homes assessed unde�l.C.E1-1-7;
See reverse side for addifional instruction and qualifications. ��e�n ��� 15 and March 31 0l the year
the deduction is to 6e effective.
or contracf bi
applirant thQ sde legal or
\/
iame on record is difterert�
ime of contract seller (app
Idress of conVaU seller
Was the applicani 65 years
prior ro the current year?
ovmef.�
Q Yes ❑ No
than ihat of aoolican
must have been
If No, what is his/her exact sharp or interest?
on
❑ Yes ❑ No
age or more on December 37 of Ihe year
❑ Yes ❑ No
Appliwnt's date of birth (month, day, yearJ
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If fded by a surirving, unmarried spouse, what was the spouse's age at
ihe time of death?
you
you
any
❑ Yes ❑ No
❑Yes ❑No
least one (1) yearJ
I with someone other than spouse,
with whom
� Real property ❑ Mobile home (I.C. 6-7-1-n
nssessed vawe ot ine property as
exceed $144,000)
Does the combined annual adjustf
individuals sharing ovmership exa
$
INVe certify under penalty of perjury that the above and foregoing information is true and correct and lhat the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
7nat e f applicani � Signature of authorized representative (by executed Power ofAttomey)
of authorized representalive
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