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STATEMENT OF MORTGAGE OR CONTRACT
INDEBTEDNESS FOR DEDUCTION FROM ASSESSED
VALUATIO� State Form 43709 (1-90) Prescribed by the
State Board of Tax Commissioners
f.�e $1.00
Township Year
4l� � � ��1 � Mark
Instructions for filing:
To be fil-�d in person or by mail with the County Auditor of the county where theOCT 6 �99�
property is located during tne 12 months before May 11 of the year the dedu on
is to be effective. See reverse for additional instructions and qualification
, _:.�
..,__-;;�:o:: T�nuoiTOR
Applicant (Owner or contract uyer - see restrictions on reverse) C�'-�^-vd'
Taxing District Key Number/Legai D ription Record No.
Q - (�/ Page No. �2��
Assessed value of real property as Mortgage/Contract Indebtedness unpaid Is the applicant the sole legal or
of March 1, current year as of March 1, current year. equitable owner? O yes ❑ no
If no, what is hislher exact share or interest? If owned with someone other than spouse,
indicate with whom.
If name on record is different than that of applicant, indicate below: c� - G-G� - /- ��• G
^�me of mortgagee or contract sell � n� .
.!Y
Addre�s of mortgagee or contract seller
Name of Assignee or other owner or holder of Mortgage.
Address of Assignee
Does applicant own real property If yes, what county? What Taxing District? Has this deduction been
in any other county in Indiana? requested on property for current
year? O yes O no
COUNTY BOARD OF REVIEW ACT�ON
Deduction approved in the amount of:
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,s� ,�' -aa ,s�l ,s�p� ���?8�,� �-�003 ,� �-°o
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Signature �t.G� Secretary of Board of Review Date
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I/We certify under penalty of perjury that the above and foregoing ir�formation is true and correct and that the appli-
�'s was/were a resident of Indiana and owner of the aforementioned property on March 1, 19
�i nature (owners full name) Person authorized by duly executed Power of Attorney or
by IC 6-1.1-12-.07).
Full Resident Address of Aplicant Address of Authorized Person