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e�'�"'a AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE� CoUr�rrv TOWNSHIV YEAR
-e t REQUESTING DEDUCTION FROM ASSESSED VALUATION
��• State Porm a3708 (R / 9�96)
' �'' Prescri6ed by the State Board of Tax Commissionea
Information contained in this documeni is CONFIDENTIAL pursuani �o IC 6-1.1-12-9. F �
INSTRUCTIONS FOR FILING: ,� �� ,j _
To be liled in person o� by mail with the County Auditor ol the county where the property is loca- �'�
ted during the 72 months be(ore May 77 0/ the year the deduction is to be eflective. � 20��
Deductions lor mobile homes not assessed as real property must lile between January 75 and
�Y 0 ::
Ma�ch 31.
See reverse side �a additional instruction and qualilications. r �, _,_,,, ,
�i (owngt� orpontract buyer)
_06/
sole leoal or eaui ble ne�
� � d .J -
No, what is his/her exact share of interest? If owned with someone other ihan spouse,
indicate with whom
E'%s ❑ No �
If name on record is diflerent than that of applicant, indicate below
Name of comraa seller (applicant mus( have 6een buying on contracf af /eas( one (7) Year)
Address of coniract seller
zmg di ri t �
/'�� h �
Is the property used and occupied primarily tor
hismer residence?
Was ihe applicam 65 years of age or more on Deci
prior to ihe current year?
�[. S �
ApplicanYs date
-
If filed by a surviving, unmarried spouse. what was
�he time of death?
Have you filed for any other deductions?
Have you filed for deductions in any oiher county?
Key number / Legal des<
0�9-00
fH'Yes ❑ No
mber 31 of the year
age at
Yes ❑ No
-av
Assessetl value ot Ihe pmperty as of March 1, Curreni year (may not
exceed $21,000)
S.��Q ❑Yes ❑No
Does ihe combined annual adjusted gross income of Ihe applicant and any
individuals sharing ownership exceed 520.000?
❑Yes �NO �
I/VJe certify under penalty of perjury ihat ihe above and foregoing information is true and correct and that the applicant was a resi-
dent of Indiana and owner of the aforementioned property on March 1, 79 _
7
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