Age_Zasadny� COUNTY TOWNSHIP YEAR
AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
REQUESTING DEDUCTION FROM ASSESSED VALUATIO.�NN
. S � ! State Form 43708 (R7 / SOB) � �
.� Presmbetl M the DePar�eM or Local Gaverm�ent Financx
File Maric
Infortnation contained in this dowment is CONFIDENTIAL pursuant to IC 6-1.7-72-9 and IC 6-1.1-35-9.
JAN 1 0 2008
INSTRUCTIONS: FILING DATES:
To be filed in person or by mail with the County Auditor o/ the county where '. � 1) Re� erty� the 12 months 6efore �une
the property is located. 77 of tlie�� th�duction is to be eflective.
Ql�p[lt@E`BSb�Oi'60�Wnder I.C.6-1-1-7;
See reverse side for additional instrucfion and qualifications.. between January 15 and March 31 0/ the year
the deduction is to be effective.
appupnt the sae iega� or
name on record is differen�
arne oi conVact seller (app
ddress of contract seUer
❑Yes ❑No �
�an Nat of applicant, indinte
must
on contract at least one
-14-I 8- 3D4-
❑Yes ❑No
'as �he appficant 65 years of age m rtrore o� December.31 of the year
iw to the wrrent yearl .
❑Yes ❑No
�plipnCs date
filed by a surirving, unmarried spouse, what was �he spouse's age at
e Gme of deaN?
Have you filed for arry
Have you filed for deducbons in any
�
_.:
❑Yes ❑No
irrte2st?
:G with someone other v
e with whom
spouse,
Is the property in question: �
❑ Real properry '❑ Mobile home (I.C. G14-n
Remrd number Pave number
W value of �he property as of March 1, curtent year (may not
S14d,0001 . . .
xnbined annual adjusted gross income of the applinrrt and any
sharing v.mership exceed E25,000?
❑Yes ❑No
$� _�_ .-._ --
❑Yes ❑No I
IlVJe certify under penalty of perjury lhat Ihe above and toregoing info�**+=}��n is true and correct and thal the applicant was a residenl
of Indiana and owner of [he aforementioned property on March 1, 20 _
gnature of appGcant Signature of authorized representaWe (by ezecuted Power olAttomey)
L�
representative