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__ � AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
= REQUESTING DEDUCTION FROM ASSESSED VALUATION
ti�w � Slate Fortn 43708 (R4 / 10.07 )
PrescriDed by Ihe Department of Lofal Govemment Finance
In�rortnation wntained in this document is CONFIDENTIAL pursuant lo IC 6-1.1-12-9.
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor o( lhe county where
tbe property is located.
See reverse side lor additional instruction and qualifications.
ame of appli nt (ownei
applicant the sole egal
name on record is diHer
ame of contrad seller (a
idress of contrad seller
or
or equitable owner? /,
es ❑ No
i
hat is his/h cacl share or interest?
below
must have been buying on
numberl
�s ❑ No
� applicant 65 years of age or more on December 31 of the year
the curtent year?
es ❑ No
ApplicanYs date of birth (monfh, day,
/
If filed by a surviving, unmarried spouse, what was
ihe Gme of death?
Have you filed for any other deductions?
Have you filed for deductions in any other county?
one
_ ✓
he spouse's age al
If Yes,
❑ Yes 1�}1Jo
� Yes 11�'No
COUNTY TOWNSHIP YEAR._
ile rk
FILING DATES: �UL `z 3 ZOOZ
1) Real properry: Durrng the 12 tF,s before May
11 of fhe yea�the deducti n�0 6e e ecti�e.
2) Mobile homes�asse
between J nua,ry�15a7iB�VN��hf9-1�o�i �ear
the deduction is to be etfective.
If owned with someone
indicale with whom
Is the property in question:
spouse,
❑ Real property ❑ Mobile home (I.C. 61-1-n
Record number Page number
property as of March 1, current year
$ �
IlWe certiry under penalry of perjury that the above and foregoing infortnation is true and correct and lhat the applicant was a resi-
dent of Indiana and owner of the aforementioned property on March 7, 20 _ .
of
0
of applicant / � Address of authorized representalive
� R � /�as �o � �-�,d � .�.,�'
executed