Age_Eckert�' °°'"�a AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, courrrv TOWNSHIP VEAR
�i� �^��1!��p' RE�UESTING DEDUCTION FROM ASSESSED VALUATION
��'yf �• Sta:e Form 43708 (R / 9-96)
�' � y�"��' PreSCribed by the State BOard of Taz Commissioners
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Information contained in this document is CONFIDENTIAL ursuam to IC 6-7.7-12-9. ;� y �
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INSTRUCTIONS FOR FILING � � �
To be Iiled in person or by mail with the County Auditor o/ the county where the property is loca- ��Y O^?�00
ted during the 72 months be)ore May 71 0/ the year the deduction is to be e77ective. �
Deductions for mo6ile homes not assessed as real propeRy must �lile benveen January 15 and -, n
Ma�ch 31. � � C�j�
See reverse side (or additional instruction and qualifications. '''^'`""'-�!!� �iti �
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Name of applicant (owne. or contract 6uyer)
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Is applicani the sole legal or equit ble owner?
hi5fier
�Wes �� No �
It name on record is different ihan at of applicant, indicate below
Name of contracl seller (applicanf must have been buying on crontract at
ss ot contract se
) district
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property used a��
r residence?
the applicant 65 years of age or more on
to ihe currem year?
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one
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II aWnetl Wlth SOmBOnB Olh2r [hdn SPOUSB.
indicate with whom
ASSessetl value of ihe property as of MarU 1, Curreni year (maynot
exceed 527,000)
❑ No ❑ Yes o
he year poes the combined annual adjusted qross income of the applica t and any
individuals sharing ownership exceed 520,000?
�pliranYs date of birth (month, day, yearJ \
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filed by a surviving, unmarried spouse, what was the spouse's age at
e time of death?
you filed for any other deductions?
Have you filed for deductions in any other counry?
Yes ❑ No
❑ Yes
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant was a resi-
dent of Indiana and owner of the aforementioned property on March 1, 19
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4ddress of aAplicant (� � Address of authorized representative
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