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AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, couNrr TOWNSHIP v�
REQUESTING DEDUCTION FROM ASSESSED VALUATION
J State Form 43706 (R7 / SO6)
Presrnbed by Ihe Departrnent of Local Gwemmeni FinarKx
File Mark
Information wniained in Ihis document is CONFIDENTIAL oursuant to IC 6-1.1-12-9 and IC 6-'1.135-9. `
INSTRUCT/ONS:
To be filed in person or 6y mail with the County Auditor of the county where
the property is located.
See reverse side for additional instruction and qualifications.
sole legal or
name on
Narne of mntrad
share w interest?
Yes ONa
thaf of applinnt,
been buying on contrdct at least one
Address of contraG seller
'ng distritl
��
Is the pmperty used and ocapied p nly for
his/her residence?
�
Was ihe appiirznt 65 years of age w more on Dea
prior to the wrrent year?
Applicant's date oi
If filed by a surviving, unmartied spouse, what was
the time of death?
Have you filed fw any other deductions?
you filed for deductions in any other
FILING DATES:
1) Real property: During the 12 months before �une
11 of the year the deduction is to be e8ective.
2) Mobile homes assessed under I.C.6-1-1-7;
$e�l��n nua�a�h 31 of the year
��d uc onis e ect
lV
number / Legal descnption
�G-1 µ�15'-ao%oo�38/-t��
0 No
of the year
❑No
$144,000)
JUN 3 0 2008
than spouse,
COUNTY AUDITOR �
15 ihe property in ques6on: - �
�eal property ❑ Mobile home (I.C. G7-1-n
Remd number Page number
property as of March 1, current year
ombined annual adjusted gross incane of the applipnt and any
sharing ownership exceed 525.000?
!
❑Yes �No I
I/We certify under penalty of perjury that the above and foregoing info�**+����n is Irue and correct and Ihat the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 .
gnature applicant Signawre of authorized representaWe (by erecuted Power ofAttomeyJ
e �.�, � ���.-� _
applinnt
�3�5 ���,
a
P.ddress of