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STATEMENT OF MORTGAGE OR CONTRACT INDEi3TEDNEgc
FOR DEDUCTION FROM ASSESSED VALUATION
StateForm43709 (R6I5-O6) � -
Presaibed by Department of Local Gwemment Finance
INSTRUCTIONS:
To be filed in person or by mail with fhe County Auditor ot the county whe�e the property is
Filing Dates: 1) Real Property: Dunng lbe 12 months before June 17 0( the year the deduction is to be��ct�� 2007
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the y e educUon is to be eflective.
See �everse side for additional inslruclions and qualifrcations. �� ��
TY AUDITOR
Applicant (owner or contract buyer - see restnncfions on reverse side) •
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Tacing Distrid Key number / legal description � Record number
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a(o_a 3_/(�-0"1 CY�-Cr� /. 9l� J`� �� �/ Page number
Asse ed value of real property as of Mortgage / ContraIX indebtedness unpaid as of Is the applicant e sole legal or equitable
March 1, curcent year March 1, curtenl year owneR �'❑ 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 lhan that of applicant, indicate betow: Is the property in question:
I Property ❑ Mobile Hmie QC 61.1-�
�me of mortgagee or contract sei� �
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Address of mortgagee or contrect 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)
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 yeaf? 0 Yes� No
COUNTY AUDITOR
Deduction approved in the amounl of:
20 �'� 20 �� 20 20 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 corred and thal lhe applicants was / were
esidenl of Indiana and owner of the aforementioned property on March 1, 20
Signature owne/s ful�e) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Full resideni address of applicant Address of authorized person
.2ro7 e 'Presley L.�
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