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' ej �'a AFFIDAVIT OF PERSON� 65 YEARS OF AGE OR MORE, courrrv TOWNSHIP YEAR
�"� ` RE�UESTING DEDUCTION FROM ASSESSED VALUATION
��`y[��' State Form d3708 (R / 9-96)
' �,s�: "-'•• P�escribeE by Ihe State eoara oi Tav Commissioners
Iniormation wntained in this document is CONFIDENTIAL pursuam to IC 6-1.7-72-9.
File Mark
INSTRUCTIONS FOR FILING: � � � �, �
To be (iled in person or by mail with the County Auditor o) the county where the property is loca- � r
ted during the 72 months belore May 77 0! the year the deduction is to be el)ective.
Deductions lor mobile homes not assessed as real property must tile between January 15 and �`� Z���
March 31. /
See reverse side for additional instruction and qualilications. �` / (� /j �]
or
name on
Ii1►Q
O Yes ❑ No �
than thai of applicant, indicate below
con[ract seller (applicant must have been buying on cont.act at
�
property use
r residence?
seller
the applirant 65 years ot age or more on
to the current year?
you filed for any other dec
i� i
i
yqu filed r de ctions in
/ . n /1 �.A.
❑ Yes ❑ No
mber 37 of ihe year
spouse, what was the spouse's age at
�5 ❑No
[&Yes ❑ No
exaci share
one
;�r,,..n,1
Ii ownetl with someone
indiCate with whom
number
S
ihan spouse,
Page number
�d value of the property as of March 1, current year (may nof
,s2i,000�
❑ Yes � No
�mbined annual adjusted gross inwme of the applicant and any
sharing ownership exceed $20,000?
❑ Yes �
Source oi Income Amount of Incom
Yes, what deductions?
Yes, what County?
$
$
TOTAL � $
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 ihe aforementioned property on March 1, 19 � '
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