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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Fwm a3709 (R4/ 10-Oi)
PrescriDetl by Departmenl of Local Govemment Finante
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor ol fhe county where the prope�ocated. �
Filing Dates: 1) Real Property: During the 12 months before May 11 0l the year the deductioy'��� F�E �R�[}�
2) Mobile Homes assessed under IC 6-1.1-7: Between Januarv 15 and Ma�ch 31 0/ the vear the deduction is to be eHective.
See ieverse side /or additional instructions and qualifications.
GIR/��( y .1UOITOF
Applican ne�orcontracf 6uyer- e iesMdi s on reverse e) � �, �
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Taxing Dislrid Key number / legal descripti Record number Q/
� �Q � _ M��� Page number ����
d�J
Assessed value of real property as f Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, cunent year March 1, current year owner? ❑ Yes ❑ No
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If no, what is his / her exact share of interest? If owned wifh someone other than spouse, indicate with whom.
If name on record is different ihan that of applicant, indicate below: Is the property in question:
❑ Real PropeAy ❑ Mobile Home (IC &1.1-�
�me of mortgagee or contrad seller �
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Address of mortgagee or conVact seller umber and street, city, state, ZIP
Name of assignee or olher owner or holder of mortgage
Address of assignee (num6er and street, ciry, state, ZIP code)
Does applipnl own property in any other If yes, what county? What Taxing Distr.c!? Has this deduclion been requested on
county in Indiana? property for curcent year?� Yes❑ No
couNrr auoiroR
Deduction approved in the amount of:
20 20 20 0 20 20 20�� 20
aA— � � � P
Signature County Auditor Date
�/ We ceAify under the penalty of peryury that the above and foregoing information is true and correcf and that the applicants was / were
resident of Indiana and owner of the aforemenlioned property on March 1, 20
Sip(�ature own ls 11 na ) Person authorized by duty executed Power of Attomey
�� or by IC 6-1.1-12-.07
F�II resident address of applica � Address of authorized person
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