Age_Sutton�j °'"o AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
` t RE�UESTING DEDUCTION FROM ASSESSED VALUATION
State Form 43708 (R / 9-96)
.,��' PreStnbed by�he S�ate Board o� Tax Commi55ioners
Iniormation contained in Ihis 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 12 months belo�e May 71 of the year the deduction is to be eflective_
Deductions lor mobile homes not assessed as �eal property must lile beRveen January 75 and
March 31.
See reverse side (or additional instruction and qualilications.
COUNTY TOWNSHIP YEAR
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Name
❑ No
If name on record is diNerent ihan that of applicant, indicate below
Name of contract seller (applican( musf have been buying on cont�act at least one (1) yeai)
Address of contract seller
�ing district Key number / Legal descripiion Record number Page number
` �/9-00 -cd
Is t e property used and occupied primarily for Assessed value ot tne property as of March 1, current year (maynot
hisMer residence? exceed 527,000)
�Yes ❑ No ❑ Yes ❑ No
Was the applicant 65 years of age or more on December 37 of the year poes the wmbined annual adjusied gross income of ihe applicani and any
prior to the curreni year? individuals sharing ownership exceed 520,000?
❑ Yes ❑ No
Appliranfs date of birth (month, day, yearJ
Have you filed for any other deductions? If Yes, what deductions?
❑ Yes �No
Have you filed for deductions in any oiher county? I( Yes, what county?
❑ Yes Zl No
I/VJe certify under penalty of perjury that the above and foregoing information is true and correc4 and that the app�icant was a resi-
dent of Indiana and owner of the aforementioned property on March 1, 19
Signature of applicant iC�+^""""' `" Signature ot authorized represeniative (by executed Power o7AttomeYl
dre s o applicant Address of authorized representative