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i i'• "� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'i' = FOR DEDUCTION FROM ASSESSED VALUATION
•:... u. y State Fortn 43709 (R6 / 5-06)
� Presai6ed by Department of Local Govemment Finance
INSTRUCTlONS:
To be filed in pe�son or by mail with the County Audilor of the county where the property rs /ocai
Filing Dates: 1) Real P�operty: DuAng the 12 months before ,lune 17 01 the year the deduction is to be eflective. '�/ l�
2J Mobile Homes assessed unde� IC 6-1.1-7: Between January 15 and Ma�ch 2 of the year the dedud�ls�tp he e/fective.
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oee reveise s�ue w� euumuna� msuucuons ana quanrrcanons. � -��
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Applicanl (owner or confract buyer - see rest ' ions on ieverse side) � UNT y A�D�TOR
Taxing Distrid • ey number / legal description ' Record number
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Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year ownef? � Yes ❑ No
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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 diHerent than that of applicant, indicate below: � Is the property in question:
eal Property ❑ Mobile Hmie (IC 51.1-�
me of mortgagee or contrad seller
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Address of moRgagee or conVacl seller (number and street, city, tate, ZIP i
Name of assignee or other owner or holder of mortgage
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Address of assignee (num6er and street, city, state, ZIP code) _�. �� - I � "
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Does applicant own property in any other If yes, what county? V'' .•••"" �.� ('j,rt� equesled on
county in Indiana? Ca� � \� • •' � n �G �� � , _ar? � Yes ❑ No
, � �U�. �o� �-
COUNTY AUL
Deduclion appro�•ed in the amount oi:
20 O 20 � 20 �_ 20 20 20 20
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Signature County Auditor Date
We certiy under the penalty of perjury that the above and foregoing infortnation is true and corred and that the applicants was / were
resideni of Indiana and owner of the aforemenlioned property on March 1, 20
Signature, (owne� /ull nam Person authorized by duly executed Power of Attomey
rIAM �,� �l �'� or by IC 6-1.1-12-.07
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F II residenl addre s of applicant Address of authorized person
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