Age_Thorne�
AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, couNTV TOWNSHIP veaa
REQUESTING DEDUCTION FROM ASSESSED VALUATION
� State Fmn 43708 (R7 / 506)
Presrnbed by the Deparhnen[ oF Loral Govemment Fuarxe
File M
�nalion coniained in Ihis document is CONFIDENTIAL pursuani to IC Cr1.7-12-9 and IC 6-1.1-359. �����
INSTRUCTIONS: FILING E
To be filed in person or by mail with the County Auditor ol lhe county where 1) Real property: During the 12 months before �une
the property is located. 11 of the ygp6;hegl�u�(�is to be eBective.
2J Mobile hoh5'€s assessed under I.C.6-1-1-7;
See reverse side !or additional instruction and qualifications. be[ween J���rch 37 of the year
fhe deducti ve.
Name of appl" t(owner or contrad b
Is applicant the e legal or equitable �
❑ Yes
If name on remrd is ditferent than that
Name oi contract seller (applicant mus
Address oF contract seller
Taxing districl
�e pro used and ocapied p�
(�an�o►�'N C'�,w�-
If No, what is hisTher exact share w interesl?
❑ No
been buying om m�6ad at
number / Legal desuiption
. � _�g.
m
�Yes
Was ihe ap�ipnt 65 years of age or more on
priw to the arrent year?
ApplicanPs
If Aed by a surviving, unmartied spouse, what
the time of death?
Have you filed for any other deductions?
Have you filed fw deducbwis in any other cw
Decembec3l of Ihe year
❑Yes ❑No
was ihe spouse's age at
❑Yes ❑No
If owned vritli someone other than spouse,
indirate with wtwm
property in question: -
❑ Real property ❑ Mobile home Q.C. 6-1-1-�
Recad number Pagenumber
.oQO-�
Assessed value of ihe property as
exceed S 744, 000)
iustetl gross inta
exceed E25,000?
� ❑Yes ❑No
I/We certify under pen of perjury tha[ the above and foregoing info�**+����n is true and correct and tha[ the applicant was a resident
of Indiana and owner of the mentio d property on March 1, 20
gnatu applipnt �1 Signature of authorized representalive (by erecuted Power ofAttomeyJ
applicant