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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
State Form 43709 (RS / 4-03)
Prescribed by Departmem of Local Govemment Finance .--� �
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INSTRUCTIONS: File Mark
To be filed in person or by mail with the County Auditor ot the counry where the propeRy is loc�t�d� `Z 4 ZO��
Filing Dates: 1) Real Property: Dunng the 72 months be(ore May 11 of the year the deduction is to be eflective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year fhe deduction is to be eNective.
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See reverse side for additional instructions and qualifications. �!�?-. -`^^`°.>'`�
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Applicant ner or contract buyer - see restnctions on reverse side) 7
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Taxing Dislrid Key number / legal description Record�mber _ O�
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Assessed vatue of real property as o Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curtent year March 1, currenl year owneR ❑ Yes ❑ No
If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different ihan that of applicant, indicate below: Is lhe property in question:
❑ Real Property ❑ Mobile Home QC 61.1-�
�me of mortgagee or contrad seller �
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Address of mortgagee or contrad seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
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Address of assignee (num6erand st2et, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing District? Has this dedudion been requested on
counry in Indiana? property for current year? 0 Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 �_ 20 L� 20 � 20 0� 20 �_ 20 20
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Signature County Auditor Date
�/ We certify under the penalty of perjury that the above and foregoing information is lrue and correct and that the applicants was / were
�resident of Indiana and owner of the aforementioned property on March 1, 20
ig ture (owner's full name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
ull re dent address of applipnt Address of authorized person .