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� AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
' REQUESTING DEDUCTION FROM ASSESSED VALUATION
S,��� State Fortn 43708 (RS / 6-03)
PrescnDed by tAe Departrnent af Loral Gwemment Finance
Irformation wntained in this dowment is CONFIDENTIAL pursuant to IC 61.7-12-9.
�TRUCTIONS: ,
To be filed in person or by mail with the County Auditor of the county where
the property is located.
See reverse side (o� additional instruction and qualifications.
COUNTY TOWNSHIP YEAR
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FILING DATES: �y � " � �UU,�
1) Real property: D nu ng the 12 months bePore May
11 of the year toe deductioryis�to,be' effec8ve.
2) Mo6ile homes assessed�undeil;C.6-f�1�7�rt
between January 15 and March 31 ot the year
the deductian is to be eHective.
Name ot appliwnt (owner orcontract buyer)
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Is applicant the sole leqal or euuitable owneY! If No, what is hi'7s her exaci share or interest? If owned with somaone other than spouse,
indicate vriN whom
�Yes ❑ No
If name on record is diftarent than Nat of appiicant, indicate below
Name of contrea seller (applicant must have been buying on cont2ct at least one (7) yrear)
Address of contract seller Is the property in question:
(�eal property ❑ Mobile home (I.C. 6-1-1-�
Ta�ting dislriIX - Key number / Legal descriplion Record number Page number
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�tie property used and ocapied primarily for Assessed value of Ne property as of March 7, curtent year (may not
her residence? � exceed 8744,000)
`CJ Yes ❑ No � a(� �f
Was the applicant 65 years of age or more on December 31 of the year
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Have you filed for any other deductions? I( Yes, what deductlons?
❑ Yes D-1Qo
Have you filed for deductions in any other county? If Yes, what count�!�
❑ Yes �►do
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INJe certify under penalty of pery'ury that the above and foregoing infor ation is true and correct and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _ �
Signature of applicant Signature of authorized representative (by executed Power olAttomey)
Ad ress o( appliwnt Address of authorizetl represen[ative
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