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��� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�S FOR DEDUCTION FROM ASSESSED VALUATION un s Year
`���. State Form 43709 (R6 / SO6)
�• Presaibed by Deparimenl of Laal Gwemment Finance
INSTRUCTIONS: �� ���
To be filed in person or by mail with the County Auditor of the county where the property is located.
Filing Dates: 1) Real Property: Du�ng the 12 months befoie June 11 0/ the year the deduction is to����%d@UNTY AUDITOR
2) Mo6ile Homes assessed unde� IC 6-1.1-7: Between January 15 and March 2 0l the year the deduc6on is to be eHective.
See reverse side for additional instructions and qualifications.
, �- -G$'
Appli (owner or contract buyer- see restricfions on teverse side) �
O
Taxin istrict Key number/ legal description Record number �DO Q
' aG -!5'- /8 - yo,3 - 000. �
O���y..p� Page number
,30)- 00 � �pSB
Assessed value of real pro rty as of MoRgage / Cantract indebtedness unpaid as of Is the applicani the sole legal or equilable
March 1, current year March 1, current year owneR ❑ Yes ❑ No
3 �� 5��
If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate wilh whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
❑ Real Property � Mobile Home pC 61.1-�
e of mortgagee or coniract seller y
`r1�1 � Iz 4 ,
Address of mortgagee or conVad seller (number an street, aty, state, ZIP --- — -—
Name of assignee or other owner or holder of mortgage �/�Q �Q'
Dra�►�er NOaV/.�jV..:. ..V.`.'.
Address of assignee (number and street, city, state, ZIP code)
Cnard NO. . ................
Dce � pplipnt own property in any other If yes, what county? What Ta �� '�`� �/�il /�� p p :sted on
coun in Indiana? � .7`'f, � `esO No
COUNTY AUDITOR
Dedudion approved in the amount ot:
20 �g 20�� 20 20 20 20 20
P e
Signature County Auditor Date
e certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
_sident of Indiana and owner of the aforementioned property on March 1, 20
Sig�ature (owners full name) Person authorized by duly executed Power ot Attomey
� � or by IC 6-1.1-12-.07
II reside addre of applipnt Address of authorized person
a .