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,..R•na AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
°"_� REQUESTING DEDUCTION FROM ASSESSED VALUATION
: Siate Form 43708 (R2/12-99)
Prescribed by ihe State Board of T� Commissioners
Information contained in this documeni is CONFIDENTIAL pursuant to IC 6-7, t-12-9.
INSTRUCTIONS FOR FILING:
To be (iled in person or by mail with the County Auditor of the counry where the property is
located during the 12 months before May 11 of the year the deduction is to be effective.
COUNTY TOWNSHIP YEAR
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(�AY 10 2000
Deductions (or mobile homes not assessed as real property must file between January 15 and/ �
March 31. - � r�.�c,u�-�
See reverse side lor additional instruction and quali(ications. �' GIc3pN �jU TY ��pITOn
Name of appl� (owner or coniract bu er)
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Is applicant the sole legal or eqw able owneR If No, what is his/her exact share or inierest? If owned with someone other than spouse,
indicate with whom
es ❑ No
If name on record is diflerent than that of applicant, indicate below
Name of contract seller (applicant must have been buying on contract at least one (7 ) year)
Address of coniract seller
�ng distnct Key number / Legal descnption Record number Page number
3l8'1-00
Is the real property used and occupied Assessed value of the property as of March 1, current year (may not
primarily for his/her residence? / exceed S23,000)
dS'es ❑ No
Was ihe applicant 65 years of age or more on December 37 of the Does the combined annual adjusted gross income of the applicant and
year prior to the current year? any individuals sharing ownership exceed 525,000?
❑ Yes ❑ No ❑ Yes ❑ No
Applicant's
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Have you filed for any other deductions? If Yes, what deductions �
1
❑ Yes ❑ No
Have you filed for deduciions in any other county? If Yes, what county?
❑ Yes ❑ No
VWe certify under penalry of perjury that the above and foregoing information is true and correct and that the applicani was a resident
of Indiana and owner of the aforementioned property on March 1, 20
nai e of applicant Signature of auihorized represeniative (by executed Power of Attomey)
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Address of applicant Address of authorized represeniative �
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