Age_Coleman, R,,,
AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, couNrr TOWNSHIP rena
REQUESTING DEDUCTION FROM ASSESSED VALUATION
. S�! State Form 43708 (R7 / 5-06)
� Presmbed by tlre DeP��ent of Local Govemment Finarcx
File Mar1c
I ormatlon contained in Nis document is CONFIDENTIAL Dursuant to IC 6-1 J-12-9 and IC 6-1.7-35-9.
INSTRUCTIONS:
To 6e filed in person or by mail with the County Auditor of the county where
the property is located.
See reverse side for additional insfruction and qualifications.
No, what is hisTher exact share w interest? If owned vrith saneone other than spouse,
' indira�e with whom
�es ❑No
ihat of applipnt,
(� ' , � � •
tt�e applicant 65 years of age or more on
[o the arrenl yearl
laanPs date
.
spcwse's age at �
❑Yes
you filed for deductions in any other cwnty?
Is ihe property in quesl
�teal property
Remrd number
� T✓7 VIN� �� "
Assessed value of the pn
exceed 8744,000)
Dces the combined annu
individuals sharing ownei
$
❑Yes �lo �
I/We certify under penalty of perjury that the above and foregoing info�**�=���n is [rue and correct and that the applicant was a resident
of Indiana and owner of the aforementloned property on March 1, 20 _
onataraot apdicant _ /� SignaNre o( authorized representaWe (by erecuted Power ofAttomey)
appliqnt 1` _ (\ {> ^ . (-� , �1 �1
S� J 'v • �"�'^ 1�\ \ �� l�?�Eh o�o�
Address of authorized