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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
• FOR DEDUCTION FROM ASSESSED VALUATION
�. ! State Fam 43709 (RS / 4-03)
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Prescn�ed by Departmem of Local Govemment Finance
INSTRUCTIONS:
Coun Township Year
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To be Iiled in person or by mail with the County A�ditor of the county where the property is located. '
Filing Dates: 1) Real Pioperty: During the 12 months 6efore May 11 of the year the deduction is to be effective. �
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year the deduction i�to be e ecbve.
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See reverse side /oradditional instructions and qualifications. 31°SC '`G'^:TV �U7!TC^
A licant (owner or contrac uyer - see restrictions on reverse side)
Taxing Distrid Key number / legal description Re d number
C�/��-�'yU (��- (� a� t�,s' � Page number
As ssed value oi real property as of MoAgage / Contracl indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, wrrent year March 1, current year owneR J� 1`€s ❑ No
/ oad
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 different than that of applicant, indicate below: Is th/e property in question:
� � C.�eal Property ❑ Mobile Home QC 61.1-�
•ne of mortgage r contrad seiler �
Address of mortgagee or contrad seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (numberand sf�eet, city, state, ZIP code)
Does applipnt own property in any other If yes, what county? What Taxing Distrid? Has this deduction been requested on
counfy in Indiana? property for wrrent year?� Yes❑ No
� 3 _ �_ �� COUNTY AUDITOR
Deduction approved in the amount of:
20 n. 2p �_ 20 �� 20 Q�_ 20 20 20
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Signature County Auditor Date
.We certify under the penalty of perjury that the above and foregoing infortnation is true and correct and that the applicants was / were
esident of Indiana and owner of the aforementioned property on March 1, 20
Signature (owne/s /ull name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
ull resident addr s of pplicant Address of authorized person �\
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