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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
� a� /� Sta:e Form 43709 (RS / 4-03) '
� P2scnbeE Dy DepaRmeni of Loral Govemment Finance �� ��
INSTRUCTIONS: � � � �?
File Mark
To be filed in person or by mail with the County Auditor of the county where the property is located. (� � j 3 Z 2��5
Filing Dates: 1) Real PropeRy: Dunng the' 12 months be(o2 May 11 of the year the deduction is to be eA'ective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year� t-hye�,deduction is to be eHective.
. See reverse side for additional inshuctions and qualification� , O'�a� ���
Appticant (owneror
Taxing Distrid
buyer-see
Assessed value of real property a�of
March t, wrtent year
no, what is his / her�exad share of interest?
on
number / legal description
Mortgage / ContraG ir
March 1, rrent year
�a, ��
� r L.;
C.�/�'�
Record n
`� ,_� Page number �
J
ness unpaid as of Is the applicant lh
owne(? ❑
If owned with someone other than spouse,
If name on record is dif(erent than lhat of appiicant, indicate below:
�me of mortgagee oi contraU seller `^���
N
Address of mortgagee or contract seller (number and st2et, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (numberand street, cify, state, ZIP
Does applicant own property�in any other I If yes, what county? � What Taxing Distrid?
county in Indiana? '
Deduction approved in the amount of:
20 l �.
P
Signature
20 � i�
�
COUNTY AUDITOR
20 _Q.9_ 20 20
P
County Audifor
legal o{ equitable
with whom.
Is the property in question:
❑ Real Property ❑ Mobile Home pC 67.1-�
a
Has this deduction been requested on
property for wrrent yeaf?� Yes❑ No
20
20
( We certify under the penalty oi perjury that the above and foregoing information is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
3 u,rg,(owners (ull name) , ^ Person authorized by duly executed Power of Attomey
1'Sa . I„�. ,, n(. 1 ne. ---- -- o� by ic s-i.�-iz-.o�
Full lesident address of appiicant �Address of authorized person