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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 43709 (R4 ! 10-Ot )
Prescribe0 by Departmenl of Local Govemment Finance
Coun Township Year
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INSTRUCTIONS: File Mark
To be filed in person or by mail with the County Auditor of the county where the property is located. �R 1 9 2��2
Filing Dates: 1) Real Property: Dunng the 12 months before May 11 0l the year the deduction is to 6e eHective.
2) Mobi/e Homes assessed under IC 61.1-7: Behveen January 15 and March 31 of the. year the deduction is to be eNective.
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See reverse side /or additional ins6uctions and qualifica6ons. GIBS(i,; .;UUtc7Y AUDITOR I
Applicant (o er or contract buyer - see sMctions on re e se ide) ,
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Taxing Dis rid Key number / legal description Record number
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Assessed value of real prope as of MoRgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, wrrent year owne(? � Yes ❑ No
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If no, what is his / her exacl share of interest? Ii 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 Property ❑ Mobile Home (IC 61.1-�
me of moAgagee or contrad seller
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Address of mortgagee or wntrad selier (numb and st�eet, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and street, city, s[ate, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? property for current yea(? 0 Yes � No
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COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 Q� 20 [i� 20 20 �i� 20
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Signature County Auditor Date
/ We certify under the penalty of perjury that the above and foregoing information is true and corred and thal ihe applicants was / were
. resident of Indiana and owner of the aforementioned property on March 1. 20
Signature (owners /ull name) Person authorized by duty executed Power of Attomey
or by IC 6-1.1-12-.07
ull resident address of applipnt Address of aulhorized person