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AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, County Township Year
REQUESTING DEDUCTION FROM ASSESSED
VALUATION State Form 43708 (1-90) Prescribed by the /'� �
State Board of Tax Commissioners `�
Instructions for filing:
To be filed in person or by mail with the County Auditor of the County where the
property is located during the 12 months before May 11 of the year the deduction
is to be effective. Deductions for mobile homes not assessed as real property
mustfile betweenJanuary 15 and March 31. See reverseforadditional instructions
and qualifications.
Appiicant (Owner
Is applicant the sole legal or If no, what is
equitable owner? O yes O no interest?
If name on record is different than that of applicant, indicate below:
contract
Address of contract seller
must
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Is the real property used and occupied primarily
for his/her residence? O yes O no
Was the icant 65 years of age or more on
Dece er 31 of the year prior to the current year?
yes ❑ no
Does the combined annual adjusted gross
income of the ap cant and any individuals
sharing owne ip exceed $15,000?
O yes no
Have you filed for any other deductions?
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If owned with someone other than
spouse, indicate with whom.
buying on contract at least one (1) year.)
Have you filed for any deductions in any other county?
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Record N
Paae No.
Assessed value of the property as of March 1, current
year (may not exceed $19,000).
If yes, what deductions?
If yes, what county?
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the appli-
cant was a resident of Indiana and owner of the aforementioned property on March 1, 19
Authorized Representative (by executed Power of Attorney)
's of Applicant Address of Representative
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