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STATEMENT OF MORTGAGE OR CONTRACT
INDEBTEDNESS FOR DEDUCTION FROM ASSESSED
VALUATION State Form 43709 (1-90) Prescribed by the
State Board of Tax Commissioners
Instructions for filing:
To be filed in person or by mail with the County Auditor of the county where the
property is located during the 12 months before May 11 of the year the deduction
is to be effective. See reverse for additional instructions and qualifications. �
Of
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ctb yer�eb,
Assessed value of real property as
of March t, current year
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Number/Le Description ° Record No.
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Mortgage/Co�
as of March 1
If no, what is his/her exact share or interest?
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No.
Indebtedness unpaid Is the applicant the. sole legal or
�nt year. equitable owner? O yes � no
If owned with someone other than spouse,
indicate with whom.
If name on record is different than that of applicant, indicate below:
of mortgagee or contract
er
Address of mortgagee or contract
Name of Assignee or other owner or holder of Mortgage.
Address of Assignee
Does applicant own reai property If yes. what county? What Taxing District? Has this deduction been
in any other county in Indiana? requested on property for current
year? O yes O no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
1
Signature
Secretary oi
19
a.Q- � o0 5
of Review � Date � � ,�
� '-�'�iz
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the appli-
��ts was/were a resident of Indiana and owner oi the aforementioned property on March 1, 19
„�gnature (owners full name) �/ Person authorized by duly executed Power of Attorney or
✓,.lY.l T,. �..�1.. � h�. 1. by IC 6-1.1-12-.07).
I Resident A�Iress of Aplicant � Address of Authorized Person
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