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dj^"v AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
t RE�UESTING DEDUCTION FROM ASSESSED VALUATION
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Stare Form a3708 (R / 9-96)
�',�„�'"��, Preuribed bY the State Board of Tax Commissioners
Information contained in �his document is CONFIDENTIAL pursuant to IC 6-1.1-12-9.
INSTRUCTIONS FOR FILING:
To be liled in person o� by mail with the County Auditor o/ the county where the property is loca-
ted during tbe 72 months before May 77 01 the year the deduction is to be eflective.
Deductions for mobile homes not assessed as real property must lile befween January 15 and
March 37.
See reverse side lor additional instruction and qualifications.
of applicant (ow�ei o� contrect buyer)
applicant the sole legal or equitable owner? � If No, what is hiyher exact �h�re of
❑ Yes ❑ No �
name on record is diHerent than that of applicant, indicate below
of contraci seller (applicant musf have been buying on conVact at least one (1) year)
of contraci seller
' f-J t�m
Is ihe property used ai
his/her residence?
ihe appiicant 65 years oi age or more on
to ihe current year?
etl
s age at
If Ye
❑Yes ❑No
iry? If Ye
❑ Yes ❑ No
COUNTY TOWNSHIP YEAR
File Mark
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_ . . ; . :� 'i � �=�� 1
1-�. ti J �% ��9J
. r k ��.
c-'SU . •_ , _. i � : 1'DITC:i
owned with someone other than spouse,
dicate wiih whom
number �Pagenumber
value of the property as of March 1, current year (may not
❑ Yes S�No
combined annual adjusted gross income of the applicant and any
s sharing ownership exceed 520,000? /
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 the aforementioned property on March 7. 19
of applicant
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