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� AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, couNrv TOWNSHIP veaR
. REQUESTING DEDUCTION FROM ASSESSED VALUATION -
S Spta Fortn 43708 (RS / 603�
,•�•
Prascribed by the Department ol Lowl Govemment Finance
InformaUOn contained in ihis document is CONFIDENTIAL pursuant to 1 .�-� ���' File MBfk
i�
�fRUCTIONS: � � FILING DATES:
To be filed in person or 6y mail with fhe CountyAuditor of lhe counry whe(e u 4 2001� �) Real property: Dunng the 12 months before May
the property is located. MAIC 11 of the year the deduction is to 6e effective.
2) o i Aomes assessed under I.C.6-1-1-7;
See reverse side lor addifional instrucfion and qualifications. � een January 15 and March 31 of fhe year
� ��ggpN CCUtiT� A��'!tAe deduction is to be effecfive.
or
If name on racord is difterent
contract
and
exact share or interesi? If owned wiN someone other than spouse,
indirate with whom
Yes ❑ No I
that of applicant, indicate below
on contract at least one (1J year)
�,Yes ❑ No
the applirant 65 years of age or more on December 31 of the year
to the curtent year? ,
etl by a survmi
ume of death?
Have you filed for any other
year�
�
ied spouse, what was
you filed for deductions in any other
❑ No
age
Yes ❑ No
❑Yes ❑No
Is the property in quest
� Real property
Record number
UU
;d value of Ne property as of March
8144,000)
sharing ovmership
I/We certify under penalty of perjury that the above and foregoing information is true and cortect and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
applican[
. /
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i9 ic�.y��
T�/b' -�O� S�3-Uo = /00
�/�- 00��-� _ �� iQD- ��/�
o � �-����-r�v = �o E3oo
representa[ive (by executed Power of AttomeyJ
ofauthorized representative