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STATEMENT OF MORTGAGE OR CONTRACT
INDEBTEDNESS FOR DEDUCTION FROM ASSESSED_ Cou
VALUATION State Form 43709 (1-90) Prescribed by the �
State Board of Tax Commissioners �
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Instructions for filing:
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
is to be effective. See reverse for additional instructions and qualifications.
Assessed value of real property as
of March 1, current year
reverse)
r
Mortgage/Contract
as of March_.1.. curr
If �o. what is his/her exact share or interest?
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Filin fee $1.00
r Township
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�scriptiqq� Record No.
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MAR ��gg�
Year
�e No. _�=�j �/�',`j
Is the applicant the sole legal or
equitable owner? O yes O no
If owned with someone other than spouse,
indicate with whom.
If name on record is different than that of applicant, indicate below: D-��� G� ��G/
�G-o?a-/.3- �
P' e of mortgagee or co tr ct seller
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Address
seller
Name of Assignee or other owner or
Address of Assiqnee
Does applicant own real property If yes, what county. What Taxing District. Has this deduction been
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in any other county in Indiana? requested on property for current
year? ❑ yes O no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
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19 `�( � 19 � pbj,
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Signature � Secretary of Board of Review Da �� p 9
6-. �-� s� � r,�. ��e - 6��Ff� .�� �� P P
I/We certify under penalty of perjury that the above and foregoing information is true,and correct and that the appli-
�� was/were a resident of Indiana and owner of the aforementioned property on March 1, 19
ature (owners full name) Person authorized by duly executed Power of Attorney or
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Fuil Resibent Address of Aplicant
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Address of Authorized Person