Age_Schaeferdj�PO AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
-` ' REQUESTING DEDUCTION FROM ASSESSED VALUATION
�• Slaie Form 43708 (R / 9-96)
�' Prescnbetl by the Stare Boartl ot Tax Commissioners
Information contained in this documeni is CONFIDENTIAL pursuant to IC 6-1.1-12-9.
INSTRUCTIONS FOR FILING:
To be liled in person or by mail with the Counry Auditor o/ the county where the property is loca-
ted during the 72 months be/ore May 7 7 0/ the year the deduction is !o be elfective.
Deductions !or mobile homes not assessed as real property must lile beM1veen January 75 and
March 37.
See reverse side for additional instruction and qualilications.
COUNTY TOWNSHIP YEAR
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APR 19 1999
G/'O �ggp(� t'vJ �'f'r AU�R 1
Name of applicant (owne� or conVact buyer)
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Is applicant the sole legal o quitabl wn . o, w at is If owned with someone other than spouse,
indicate with whom
Yes ❑ No
If name on record is diNerent than that of applicam, indicate below
Name of contraci seller (applicant must have been buying on contract at leasf one (7J yearJ
Address of contract seller
�xing district Key number / Legal description Record number Page number
�a
Is the pmperty used and occupied primarily for Assessed value of the property as of March 7, currem year (may nor
his/her-residence? exceed 527.000J ,�[�
s ❑ No O Yes 13No
Was the applicant 65 years of age or more on December 37 of the year
$ �
Have you filed tor any other detluctions? If Yes, what deductions?
es ❑ No
Have you filed for deduciions in any other county? If Yes, what counry?
❑ Yes �vo �
IlWe certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant was a resi- -
dent of Indiana and owner of ihe aforementioned property on March 1, 19
Signature of applicam Signature of authorized represeniative (by executed Power olAttorney)
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dress of applicant Address of auihorized representative
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