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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709 (RS / 4-03)
Prescnbed Dy Departmem of �ocal Govemment Finance
Coun Township Year
INSTRUCTIONS: Fii
To be �led in person or 6y mail with the County Auditor of the county whe2 [he property is located. �A N 1����
Filing Dates: 1J Real Property: During the 12 months 6efore May 11 0/ the year the deduction is to be effective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year tRe�e�t� js�to be eHective.
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See 2verse side for additional instructions and qualifrcations.
OIBSON COUNTY AUDITOR
Applicant (o e orcontract buyer- e restncti s reverse side) �
T'ng Distrid Key number I al description Record number �
O' I� /.��) � � —` Page number
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� Ass sed value of real property as of MoRgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, wrrenl year March 1, current year owneR ❑ Yes ❑ No
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 the property in queslion:
❑ Real Property ❑ Mobile Home (IC 61.1-�
�me of mortgagee or contrad seller
Address of mortgagee or contract selier (number and st2et, city, state, ZI
Name of assignee or other owner or holder of mortgage
Address of assignee (numbe�and st2et, city, sfate, ZlPcode)
Does applicant own property in any other If yes, what county? What Taxing Distrid? Has this deduction been requested on
county in indiana? property for current year?0 Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 D� 20 �_ 20 �� 20 � 20 20 20
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Signature County Auditor Date
� We certify under lhe penalty of perjury that the above and foregoing information is true and corred and that ihe applicants was / were
esident of Indiana and owner of the af m tioned property on March 1, 20
i lure ners me) Person authorized by duty executed Power of Attomey
or by IC 6-1.1-12-.07
Full resid nt addre li Address of authorized person
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