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��"a AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE�
-d ` REQUESTING DEDUCTION FROM ASSESSED VALUATION
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Sta;e Form d3708 (R / 9-96)
'%01:= °' Prescnbed by the State Board of Tax Commissioners
Information contained in ihis document is CONFIDENTIAL pursuani to IC 6-7.1-12-9.
INSTRUCTIONS FOR FILING:
To be liled in peison or by mail with the County Auditor of the county where the properry is loca-
ted during the 72 months before May 77 0l the year the deduction is to be e)lective.
Deductions Jo� mobile homes not assessed as real property must lile between January 75 and
March 31.
See reverse side (or additional inst�uction and quali/ications.
COUNTY TOWNSHIP YEAR �
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Name of applicant �owner o� contract buyei)
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Is ap n[ the sole �egal or e itable owner? If No, what is hisiher exact share of imerest? If owned with someone other ihan spouse,
, indicate with whom
es ❑ No
If name on record is ditterent than hai of applicant, indicate below
Name of coniract seller (applicant musf have been buying on contract at least one (7 J yea�)
IAddress of contraci seller
�<ing district , Key number / Legal description Record number Page number
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Is the property used and occupied primarily for Assessed value of the property as of March 1, current year (may not
his/her residence? exceed $27.000)
L `e ❑ No ❑ Yes ❑ No
Was the applicant 65 years of age or more on December 3� of the year poes the combined annual adjusted gross income of the applicant and any
prior to the current year? individuals sharing ownership exceed 520,000?
❑ Yes �I No
Applicant's date of birth (month, day. year)
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Have you filed for any other deductions? If Yes. what deduciions?
❑ Yes
Have you filed for deductions in any oiher county? If Yes. what county?
❑ Yes o
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the applicani was a resi-
dent of Indiana and owner of the aforementioned property on March 1, 19
ISignature ot applicant — Signature oi authorizetl representative (by executed Power o7Atlomey)
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ress of applicant , Address of auihorized representative
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