Age_Mightdd``��n�� AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
�y REQUESTING DEDUCTION FROM ASSESSED
' VALUATION.State Form 43708 (1-90) Prescribed by the
°• State Board of Tax Commissioners .-
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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
mustfilebetweenJanua 15andMarch3l Seereverseforadditionalinstructions
County � Township � Year
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'APR 2 g 1996
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and qualifications. �.�r�x� ,�, jy���
AUDITOR �'�
Applicant (Owner or tr t buyer) •
c.
Is applicant the so e le r If no, what is his/her eicact s e or If owneii with someone otfier than
equitable owner? yes ❑ no interest? spouse, indicate with whom.
If name on record is different than that of applicant, indicate below:
Name of contract seller (Applicant must have been buying on contract at least one (1) year.)
Address of contract seller
T in i+ y Key�Num dLeg�l D s�i�iqn, O� Regord No. �
-P - --�,
C� �' S� Pa e No.
Is the real property used an cupied primarily Assessed value of the property as of March 1, current
for his/her residence? yes ❑ no year (may not exceed $19,000).
Was the a �cant 65 years of age or more on ApplicanYs date of birth
Dece er 3t of the year prior to the current year?
yes O no If filed by a surviving, unmarried spouse, what was the
spouse's age at the time of death?
Does the combined annual adjusted gross
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Have you filed for any other deductions? If yes, what deductions?
Have you filed for any deductions in any other county? 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
Si�nat e Authorized Representative (by executed Power of Attorney) .
� . � �dl.r�
ress of Applicant Address of Representative
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