Age_Elliottn�
� AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, couNrv TOWNSHIP veo.R
REQUESTING DEDUCTION FROM ASSESSED VALUATION -
S � State Fwm 43708 (RS / 6-03)
. Prescribed by Ne Department ot Local Govemment Finance 'f( �
File Mark
Infwmation contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-72-9. � .IbJ
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor of the county where
the property is located.
See 2verse side for additional instniction and qualifications.
aoolicant the
name on
coniract
(owner or cont2ct buye�
/
e iegal or equitable ownefl
❑pes ❑ No
s different than that of appiicant
�,eller (applicant must have been
of contrect seller
property use
r residence?
Was Ne applicant 65 years of age or more on
prior to the current yeaR
was ihe spouse's age
any oNer
❑ Yes Q�lo
you filed for deductions in any other county?
Is the property in queslion:
❑ Real properry ❑ Mobile home (I.C. 6-7-7-7)
property as
5744,000J
sharing ownership
$ �
❑ Yes LlNO I
I/We certify under penalty of perjury that the above and foregoing information is true and corcect and ihat the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20
Signature of applicani , Signature of authorized representative (by executed Power olAttomey)
[di
����-�P¢� �y� /3 s�'
representative