Age_Bennett�
e`"'TM4 AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
a � t,' REQUESTING DEDUCTION FROM- ASSESSED
� VALUATION State Form 43708 (1-90) Prescribed by tfie
� ,e�
• � . State Board of-Tax Commissioners
InstrucUons for filing:
To be filed in person or by mail with the Couhty Auditor of the County where the
property is located during the 12 months before May 11 of the year-the deduction
is to be effective. Deductions for mobile homes not�assessed as real property
mustfile betweenJanuary 15and March 31. See reverseforadditional instructions
and qualifications.
County Township Year
File Mark �
�j-.� : ��
3 � E ,' j :
�lAY - 91995
Applicant (Own or contract buyer)
�,� �, sy�-�
, � � iTn .4
Is applicant the soie legal or if no, what is his/her exact share or If owned wifh someone other than
equitable owner? O yes O no interest? spouse, indicate with whom.
If name on record is different than that of applicant, indicate below:
Name of contract seller (Applicant must have been buying on contract at least one (1) year.)
Address of
� g District Record No.
- - Fage No.
Is the real property used and cupied primarily Assessed value of the property as of March 1, current
for his/her residence? � es ❑ no year (may not exceed $19,000).
Was the licant 65 years of age or more on
Have you filed for any other deductions? If yes, what deductions?
Have you filed for any deductions in any other county? If yes, whai county?
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the appii-
cant was a resident of Indiana and owner of the aforementioned property on March 1, 19
Siqnature Authorized Representative (by executed Power of Attorney)
�