Age_Colvin� R�,
o., s: AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, courm TOWNSHIP renrt
' ` REQUESTING DEDUCTION FROM ASSESSED VALUATION
�>�_�i Stata Form 43708 (R6 / 4-04)
•• Preunbed by Ne Department ol Local Govemment Pinance
`�nation wntained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9 and IC 6�.�1-95� � FII2 Merk
INSTRUCTIONS:
To be filed in person or by mail with the CountyAudito� o! the county where
the propeRy is located.
See reverse side (o� additional instruction and qualifications.
FIL+�G OfIT�-L��6
J IV P P m, Dunng the 12 months before May
��
11 0/ the yea� the deduction is to be eHective.
2�t� ssessed underl.C.Sf-1-7;
�e��e�,(� J,�and March 31 of the year
GIBSO c��on �s to fie effective.
Name ot applica o ner or confrect buyer) ^ �` � �
1�J
Is applicant lhe sole legal or equitable owner? If No, what is hi /her exact share or interesl? If owned with someone other than spouse,
indicate with whom
es ❑ No
If name on record is diHerent th that of applicant. indicate below
Name of conVact seller (appliranf must Aave been buying on contract at leasf one (1) year)
Zl? - Oa0 � - �
Address of conVad seller Is the property in question:
❑ Real property ❑ Mobile home (I.C. 6-1-1-7)
Ta�dng district Key number / Legal description Record number Page number
�� � - - - �a��o
� e property used and o upied primarily (or Assessed value of the property as of March 1, current year (may not
Ihis/her residence? exceed 5744,000)
es ❑ No
Was the applicant 65 years of age or more on December 37 t the year
$
Have you filed tor any other deduc6ons7 If Yes, what deducfions?
❑ Yes ❑ No
Have you filed for deductlons in any other county7 If Yes, what county?
❑ Yes ❑ No
IIWe certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _ �
ignature o( applicant Signature of authorized representative (by executed Power ofAttomey)
'�ess o applicant Address of authorized representative