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jqi A� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'e'�= FOR DEDUCTION FROM ASSESSED VALUATION � Year
. ..�i+ State Fortn 43709 (R6 / 5-06) . ,
� Presaibed by Depanment of Loml Gwemment Finarxe �
INSTRUCTIONS: `�y� �e Marfc
To be filed in person or by mail with the County Audito� of the county whe�e the p�operty is located. �"� �
Filing Dates: 1) Real P�operty: Dunng the 12 months before June Il of the year the deduction ff�g���.l' AUDITOR
2),Mobile Homes assessed under lC 6-1.7-7: Between January 15 and March 2 o/the year the deducGOn is to be eflective.
See reverse side lor additional instructions and quali(rcations.
or contract buyer- see restrictions on reverse
Taxing
Assessed value of real properfy'�s of
March 1, current year , (f
If no, what is his / her exacl share of interest?
Key number / legal description
� I� i�- /�t �.�C y-CY�r3�3i
Mortgage / Contrad indebtedness unpaie
March 1, current year
Record
R
number
as of I Is the applipnt the sole legal or
ownert ❑ Yes ❑ No
s
G�6'' �
If owned with someone other lhan spouse, indicate with whom.
name on record is different than that of applicant. indicate below:
�me of mortgagee or conVact seller
-- ou,l�
Address of mortgagee or contrad seller (number and street, city, state, ZIP
assignee o� other owneF or holder of mortgage
of assignee (numberand st�eet,
code)
Does appliwnt own property in any other I If yes, what counry? What Taxing
county in Indiana?
approved in the amounl of:
20 (,4 20
P
Signature
�
COUNTY AUDITOR
20 20 20
County Auditor
Is th@ property in question:
❑ Real Propelly ❑ Moble Home OC 61.
�
-- , 3.S y 9
pYa���er 10.0 �.. • •�
C�rd 1�•
20
Date
._y�estetl on
,...� current yeaR � Yes � No
20
We certify under the penalty of perjury that the above and foregoing informalion is true and correct and lhal the applicants was / were
esideni of Indiana and owner of the aforementioned property on March 1, 20
r/�1tnure (owner�sn /ull n me) Person authorized by duty executed Power of Attomey
I!1/Qinn•n�1C ��/)� �n/�1 orbylC6-1.1-12-.07
Full resident address of nap'plicar(j� V /� Address of authorized person
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