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AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
REQUESTING DEDUCTION FROM ASSESSED VALUATION
Slate Farm 43708 (R7 / 5-OB)
Presrnbed by ihe DepaM�ent of Loral Gwemment Finance
Infortnation coniained in this document is CONFIDENTIAL pursuant to IC Cr1.1-12-9 and IC 6-1.1-35-9.
INSTRUCTIONS:
To be filed in person or 6y mail with the County Auditor o/ the county where
the property is located.
See reverse side (or additional instruction and qualifications.
cour+TV,. s r�ars
�uL `? �tle'Mar(c
FILING DATES_ � a p
1) Real properry: Duri,{� ��'PVn6}i�fi��6efore ��ne
11 of the y6blQ�i%�uchon is to be eflective.
2) Mobile homes assessed under I.C.6-1-1-7;
6etween January 15 and Ma�ch 37 0l the year
the deduction is to be effective.