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AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
REQUESTING DEDUCTION FROM ASSESSED
VALUATION State Form 43708 (1-90) Prescribed by the
State Board of Tax Commissioners
Instructions for filing:
To be filed in person or by mail with the County Auditor of the County where the
property is located during the 12 months before May 11 of the year the deduction
is to be effective. Deductions for mobile homes not assessed as real property
mustfile betweenJanuary 15 and March 31. See reverseforadditionai instructions
and qualifications.
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Applicant (Owner or contract buyer) ,
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Is applicant the sole legal or If no, what is his/her exact share or If owned with someone other than
equitable owner? �] yes O no interest? spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: (�L� �'i_q-aa'
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Name of contract seller (Applicant must have been buying on contract at least one (1) year.)
Address of contract seller
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�xing1 ,,District Ke N er/Le al DescriptionS �� Record No.
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Is the real property use nd occupie y Asse sed value of the property as of March 1, current
for his/her residence? � es O no year (may not e eed $19�0).�T
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Was the applicant 65 years of age or more on ApplicanYs date of birth
�yes rJ no If filed by a surviving, unmarried spouse, what was the
spouse's age at the time of death?
Does the combined annual adjusted gross
Have you filed for any other deductions? If yes, what deductions?
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Have you filed for any deduE ons in any other county? If yes, what county?
IlWe certify under penalty of perjury that the above and foregoing information is true and correct and that the appli-
cant was a resident ot Indiana and owner of the aforementioned property on March 1, 19
Si nature Authorized Representative (by executed Power of Attorney)
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Address of Applicant Address of Representative
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