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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709 (R4 / 16-0t )
Prescrib�W by Depanmenl of Local Govenment Finance
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor o/ the county whe2 the property �s located. n�
Filing Dates: 1) Real Property: Dunng the 12 months before May 11 o/the year the deduction igj'�� �f�C���3
2) Mo6ile Homes assessed under IC 6-1.1-7: Befween January 15 and March/31 0/ the year the'deducINp�n ��ynss to be eHective.
See reverse side tor adddional instructions and quafi�cations. r/ �� ���^'j�P �
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Applicant (own or nhact buyer- 2strictio e e sid
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Taxing Distrid Key number / legal descri ion Record number
� %� �j , /l //_ O� / n� 'm� Page number ��
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Assessed value of real prope as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March rent year owne(? ❑ Yes ❑ No
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If no, what is his / her exad share of interest? If owned with someone other lhan spouse, indicate with whom.
If name on record is different ihan ihat of applicanl, indicate below: Is lhe property in question:
❑ Real Properiy ❑ Mobile Horne pC 61.1-�
�ime of mortgagee or contrad seller /� � ` /�
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Address of mortgagee or conVact seller (number and st2et. city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does appliqnt own properry in any other If yes, what county? What Tauing Distrid? Has lhis deduction been requested on
county in Indiana? property for current yeaf? O YesO No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 �,� 20 �� 20 �'7 20 �$_ 20 ��
P P
Signature County Auditor Date
�/ We certify under the penalty of peryury that the above and foregoing infortnation is true and corred and that the applicants was / were
r ident of Indiana and owner of the aforementioned property on March 1, 20
S' ture (owners /ull na e) Person aulhorized by duty executed Power of Attomey
� or by IC 6-1.1-12-.07
r sident address appli t Address of authorized person