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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
. ,«. ! Sfate Fwm a3709 (R5 / a�3) � . . .
� PresaibeG Oy Departmem of local Govemment Finance ��
INSTRUCTIONS: e,
To be filed in person or by mail with the County Auditor of the county where the property is located. MAR 1� L�
Fifing Dates: 1J Real PiopeRy: During fhe 12 months before 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 Maich 2 0! the year t� �? ductro� to be eNective.
See reverse side for additional instructions and qualifications. �„ „�,�,uTV Ua DITOR
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Applicant (own contract buyer-�see stnctions on ieverse side)
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Taxing Distnd Key number / legal descnption ecord number �
�{�., . 1,_ Q ( �] „ �DD��-� Pagenumber �
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Assessed value oi real property as of Mortgage ! Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March t, currenl year owneR ❑ Yes ❑ No
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ti no, what is his / her exact share ot interest? Ii owned with someone other than spouse, indicate with whom.
If name on record is diKerent than that of applicant, indicate below: Is the property in question:
❑ Real Prop�ty ❑ Mobile Home (IC G1.1-�
�me of mortgagee or contract selier �'
Address of moRgagee or conlrad 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)
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Does applicant own propeAy in any other If yes, what county? What Taxing Distrid? Has this deduclion been requested on
county in Indiana? propeAy for current year? � Yes� No
COUNTY AUDITOR
Deduction approved in fhe amount of:
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Signature County Auditor Date
We certify under the penalty of perjury that the above and foregoing information is true and corred and that ihe applicants was / were
. resident of Indiana and owner of the aforementioned property on March 1, 20
Sig a (owner's /ull n me) � Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
ull resident aqdres� of plicant Address of authorized person �
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