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STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
' ' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�. ��� J Stale Form a3709 (Ra / 70-01)
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Presaibed by Department of Local Govemment Finance
INSTRUCTIONS: Fle M�
To 6e filed in person or by mail with the County Auditor o/ the county where the property is locaf
Filing Dates: 1) Real Property: Dunng the 12 months be%2 May 11 0l the year the deduction is �ec v J.
2J Mo6ile Homes assessed under IC Sf.l-7: Behveen January 15 and March 31 of�year the dedGucJjppi,s to be eHective.
See reverse side Ior additional instNCtions and aualificaGons. .I AN L�1UJ
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Applicant (ownerorcqnt ct 6uyer- see 2stnction�s o�n reve�e) /u �I Or l` Uµ Y�.���TOF �
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Taxing Distrid Key number / legal descriptio Record number _ _�/
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�� 3_�� 73 �� Page number
Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of is the applicant the sole legal or equitable
March t, current year March 1, current year owne(? ❑ Yes ❑ No
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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 diftereni than that of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home (IC 61.1-�
�me of mortgagee or contrad seller `
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Address of mortgagee or conVact seller (number and st2et, city, te, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and street, city, sfate, ZIP code)
Does applicant own property in any other If yes, what couniy? What Taxing Distrid? Has this deduclion been requested on
county in Indiana? property for current yea(? � Yes ❑ No
COUNTY AUDITOR
Deduction approv in the amount of:
2o D 3 2o v'-f zo zo �? � zo zo �� zo 0 9
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Signature County Auditor Date
We certify under the penalty of perjury lhat the above and foregoing infortnalion is true and corted and that lhe applicants was / were
a?esideni of Indiana and owner of the aforemenlioned property on March 1, 20
Signature (owners full name) Person authorized by duly executed Power of Attomey
(—� or by IC 6-1.1-12-.07
Full resident addre s of appliqnt Address of aulhorized person
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