Age_HorathAFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE, couN o sHi
REQUESTING DEDUCTION FROM ASSESSED VALUATION
. S�w / Sfate Form 43708 (R7 / SO6)
Presv�ed by the Deparunent of Laal Govemrtrent Fviance
Fi e Ma
rtnation contained in this document is CONFIDENTIAL pursuant to IC 1.1-12-9 and IC 6-1.7-35-9. y
INSTRUCTIONS: FILING DA7ES: �+�U
To be filed in person or by mail with the Counly Audit of the cou ���,C,�-,,�here �' 1) Real properry: 9!&ki�M Qg1A8� F�b�une
the property is located. '1✓ 11 of the year the deduction is to be effective.
2 obile homes assessed under I.C.6-1-7-7;
See reverse side for additional instruction and qualific ions. b tween January 15 and March 37 of the year
./'i'l� - deduction is to 6e effective.
ie ot appiicaM (owner w conhad buyerj
� ��.� V � .
�plicani ihe e legal or equilable ovmel?
❑ No
Hnameon
contract seller (applicant must
� i
♦ � � �
plicant 65 years ot age w rtrore on
arrent year7
/�/
ried spouse, what xas Uie spouse's age at
you filed fir any other deducUi
you filed for deductions in any
DYes ❑No
❑Yes ❑No
5144,000)
I with saneone
with whom
Is the property in question:
spouse,
❑ Real property � Mobile home (I.C. 6-7-1-n
Record number Page number
as of March 1, wrrent year (may nW
�mbined annual adjusted gross income of Me appiicant and any
sharing uwnership exceed $25,0007
$
7
I/We certify under penalty of perjury that the above and foregoing info��+��n is true and cortect and that the applicant was a resident
of Indiana and owner of the aforementioned property on March 1, 20
Signatura
�
L .
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representalive (by
of authorrzed representalive
