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� AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
REQUESTING DEDUCTION FROM ASSESSED VALUATION
S � State Fortn a3708 (RS / 6A3) --
,•
PreStribeE by the Department of Lofal Caovemment Finance
tr'� atlon contained in this document is CONFIDENTIAL pursuant to IC 61.1-12-9.
COUNTY TOWNSHIP YEAR
File Mark
RUCTIONS: FILING DATES:
To 6e �led in person or by mail with the County Auditor of the counry where 1) Real property: Dunng the 12 monihs 6e%ie May
the property is located. 11 of the year the deducfiomis to be�effective
See reverse side lor additional instruction and qualifications.
Name ot
nama on recorC is ainer
ame of conirad seller (a
ddress of conVact seller
uci dist'd �
e property sed and c
. er residence?
�Or cont2ct buyer)
�
or equita6le owner?
❑Yes ❑No
ent than that of appliwn
oolicant must have 6eei
for
Was Na applicant 65 years of age or more on
pnor to the current yeaR
I/We certify under penalty of perjury thal the above and foregoing information is true and conect and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20 _
PowerolAttomey)