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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
S. / Siate Form a3709 (RS / 4-03) t� �j } �—`� �'
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� PrescriDed by Departmeni of Loral Govemmenl Finance �
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INSTRUCTIONS: `�t� Z Fi�e�-WYafk
To be filed in person or by mail with the County Auditor o/ the county where the property is located.^
Filing Dates: 1) Real Property: During the 12 months before May 11 0l the year the deduction is to�be effective.% //�/ f
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 oRiie year,the deduction'is to'be'effective.
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See 2verse side for additional instructions and qualifications.
Applicant ner ontracf buyer- ee trictio s n reverse side)
Taxin t' Key number gal scription Record number .
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Assessed value of real property as of Mortgage / ContraG indebtedness unpaid as of Is the applicant the sole legal or equitable
March i, curcent year March 1, current year ownef? ❑ Yes ❑ No
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If no, what is his / her exad share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
❑ Real Pro ❑ Mobile Home (IC 61.1-�
��ne of mortgagee or contrad seller
Address of mortgagee or confrad selier (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and sheet, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing District? Has this dedudion been requested on
county in Indiana? property for wrrent year? Q Yes ❑ No
COUNTY AUOITOR
Deduction approved in the amount of:
20 OC" 20 20 �� 20 �� 20 20 20
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Signature County Auditor Date
''�We certify under lhe penaity of perjury that the above and foregoing infortnation is true and correcl and that the applicants was / were
esident of Indiana and owner of the aforementioned property on March 1, 20
Sig ure (owne/s (ull nam ) Person authorized by duly executed Power of Attomey
�.� or by IC 6-1.1-12-.07
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ull resident addre applicant Address of authorized person
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