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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
: �w� / State Form 43709 (RS / 4-03) • �� j{ � / p� �'�� �,
� P2saibeE by Department of Loral Govemment Finance N� ll '�
JUN i��p�a
INSTRUCTIONS: i e ark
To be filed in person or by mail with the CountyAuditor of the county whe�e the property is locateii` � /)�
Filing Dates: 1J Real Property: During the 12 months before May 1 f o/ the year the deduction isktAbµe e/%ctive.�v ��
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 ot the.,y_ear the�deduc �on u to be'effeciive.
J,,. � _
See reverse side /or additional instructions and quali(cations.
buyer
Assessed value oi real property as of
March 1, current year
Ii no, what is his / her exact share of interest?
name on record is different than that ot
of mortgagee or contraIX selier
on
Key �fumber / legal description Record number
��_ �� Q�_�v Page number /
, r� •
Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current ye2r owneR ❑ Yes ❑ No
�00 ��
If owned with someone oth r than spouse, indicate with whom.
� -/3 - o . Qa - 6ao. .�a � G��
znf, indicate below: Is the orooertv in auestion:
Address of mortgagee or contract seller (number and street,
Name of assignee or other owner or holder o( mortgage
of assignee (num6er and street, city, state, ZIP code)
Does applicaM own property in any other I If y�s, what county %
county in Indiana? ,
Deduction approved in the amount oi:
20
Signature
state. ZIP
!'Jhat Taxing Distrid?
COUN?Y AUDITOR
2C
County Auditor
20 �
�
❑ Real Property ❑ Mobile Home QC E1.1-�
Has this deduction been requesled on
property for currenf yea(?� Yes❑ No
201/ 20
l /1
� 07
Date
/ We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
� resident of Indiana and owner of the aforemen:ioned property on March i, 20
full
Person authorized by duly executed Power
or by IC 6-1.1-12-.07
of appiicant �, � U` IAddress of authorized person