Age_Solomani: . . ,
.�•°'°a AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
a .� #, REQUESTING DEDUCTION FROM ASSESSED County Township Year
`` VALUATION State Form 43708 (1-90) Prescribed. by the
�° State Board of Tax Commissioners
. fi'-. '. . --� tr .
Instructions for filing: j' ���T�il I
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 "�`�� �9�
is to be effective. Deductions for mobile homes not assessed as real property��J
mustfilebetweenJanuaryl5andMarch3l.See�everseforadditionalinstructions�w.t,�,{�. �lZ�,,��-
and qualifications. aUDITOR o "
Applicant (Owner or contract b�r) ,
�
Is applicant the sole legal or If no, what is his/her exact share or If owned with someone other than
equitable owner? O yes O 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
•ing District Key Number/Legal Description Record No.
-� q— � -� Page No.
Is the real property used and occupied primarily Assessed value of the property as of March 1, current
for his/her residence? O yes ❑ no year (may not exceed $19,000).
Was th applicant 65 years of age or more on ApplicanYs date of birth
Dece er 31 of the year prior to the current year? �
es �� 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
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 arid correct and that the appli-
cant was a resident of Indiana and owner of the aforementioned property on March 1, 19
Si nature Authorized Representative (by executed Power of Attorney)
Address of Applicant � Address of Representative
63 �, �� 6-,Q,