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�,°�'a AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
-� � REQUESTING DEDUCTION FROM ASSESSED VALUATION
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Stare Form d3708 (R / 9-96)
�'�l Prescribed bY the State Board ol Ta. Commissioners
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1-12-9.
INSTRUCTIONS FOR FILING:
To be liled in person or by mail with the County Auditor o! the counry where the property is loca-
ted during the 72 months be%re May ll of the year the deduction is to be effective.
Deductions lor mobile homes not assessed as real property must file beRVeen January 75 and
March 37.
See reverse side for additional insiruction and qualilications.
COUNTY TOWNSHIP YEAR
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Name of applicant (owner oi contract buyer)
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Is applicant the sole legal or equitable owner? If No. at is his/her exact share of interest? If owned with someone other ihan spouse,
indirate with whom
❑ Yes ❑ No
If name on record is dittereni than that of applicant, indicate below
Name o( Contrac[ seller (applicant must have been buying on contract at least one (i) year)
Address of contract seller
�King dis � i ` Key number / Legal description Record number Page number
9-0� 3 - �
Is the property used and occupie primarily for Assessed value ot the property as of March 7, current year (maynot
his/her residence? ��� exceed 527,000) �1
C9'Yes ❑ No �(�,3 V ❑ Yes ❑ No
Was the applicant 65 years of age or more on December 3t of the year poes the combined annual adjusted yross income of ihe applicant and any
prior to the curreni year? individuals sharing ownership exceed $20,000?
��— � — � ❑ Yes ❑ No
App' nYS date of birth (month, day,
Have you filed for any other deductions? If YeS, what deductions?
❑ Yes L�No �
Have you (iled for deductions in any oiher county? It Yes, what county?
i
❑ Yes �No
IlWe 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
Signature of applican� Signature of authorized representative (by executed Power o/Attorney)
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.,ddress ot applicant Address of auihorized representative