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STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
�!��{,�.� FOR DEDUCTION FROM ASSESSED VALUATION
� '�/• SIa;eFOrm43709(RS/4-03)
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P25criDeE by Departmeni ot local Govemment Finance
INSTRUCTIONS:
Coun Township Year
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To be filed in person or by mail wiih the County Auditor of the county where the propeRy is located.
Filing Dates: 1) Real Property:� Dunng the 12 months before May 11 of the year the deduction is ro be eflective.
2) Mobile Homes assessed under IC 6-1.1-7: 8etween January 15 and March 2 oI the yearY��edu to be effective.
See 2verse side for additional instructions and qualifications. �
p�qgp;� COUNTY AUDITOR
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Applicant (owne or on ct 6 er - seelres ' tions on reverse side)
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Taxing Distrid Key number / legal description Record number �
Q D � /' � \ Page number �
1 CJIJ
Assessed value eal property as of Mortgage / Conlrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March t, wrrent year March 1, wrrent year owneR ❑ Yes ❑ No
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If no, what is his 1 her exact share of interest? If owned with someone other than spouse, indicate with whom.
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If name on record is diKerent than thai ot applicant, indicate below: Q` Is e property in question:
❑ Real Property ❑ Mobile Hane pC 61.1-�
.�me of mortgagee or contrad seller �
Address of mortgagee or convad selier (number and street, city, state, ZIP
Name of assignee or olher owner or holder of mortgage
Address of assignee (num6erand sf2ef, city, state, ZIP code)
Does appiicant own property in any other If yes, what county? What Taxing District? Has this deduction been requested on
county in Indiana? . propeAy for wrrent year? � Yes 0 No
COUNTY AUDITOR
Deduction approved in the amount of:
20 �� . 20 20 Q� 20 20 20 20
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Signature County Auditor Date
.' W certify under the penalty of perjury that the above and (oregoing information is true and correct and that ihe applicants was / were
a r ident of Indiana and owner of the aforementioned property on March 1, 20
t e(ow ers lull me) Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
ull ident a ress o ppli t 1 Address of authorized person
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