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STATEMENT OF MORTGAGE O.R CONTRACT
INDEBTEDNESS FOR DEDUCTION FROM ASSESSED
VALUATION State Form 43709 (1-90) Prescribed by the
State Board of Tax Commissioners
Instructions for filing:
To be filed in person or by mail with the County Auditor of the county where the
property is located during the 12 months before May 11 of the yea[ the deduction
is to be effective. See reverse for additional instructions and qualifications.
Filin fee $1.00
County Township Year
r
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4 File Mark�
�t�3 i . 1999
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Applicant (Owner or contract buyer - see restricti ns on reverse) r, •
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Tax'ing Di trict Key Num er/Legal Description . Record No. �
- J`3—C(J Page No. � 7 3
Assessed value of real property as Mortgage/Contract Indebtedness unpaid Is the applicant the sole legal or
of March 1, current year as of March 1, current year. equitable owner? �7 yes �] no
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If no. what is his/her exact share or interest? If owned with someone other than spouse,
indicate with whom.
If name on record is different than that of applicant, indicate below:
�"'ame of mortgagee or contr t seller
Address of mortgagee or contrac eller �
Name of Assignee or other owner or holder of Mortgage.
Address of Assignee �
Does applicant own !eal property If yes, what county? What Taxing District? Has this deduction been
in any other county in Indiana? requested on property for current
year? O yes ❑ no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
19��0� 19_�(i'U 19�OOZ L@p����(�� 1.8._�� � S� ,.9 2oQ�
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Signature _ Secretary of Board of Review Date /
��o� 0 0� o ��j41 �c�
I/We certify der penalty of perjury that the above and foregoing information is true and correct and that the appli-
��nts was/were a resident of Indiana and owner of the aforementioned property on March 1, 19
nature (owners full name) Person authorized by duly executed Power of Attorney or
.� 9i by IC 6 1.1-12-.07).
Full Resident Address of Aplicant Address of Authorized Person