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� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun �7ovsnship Ye;
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t / Siate Form a3709 (RS / 4-03) � . g ' � �� /
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Prescribed by Department ol Local Govemmen� Finance ly
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INSTRUCTIONS: File Mark
To be �led in person or by mail with the County Auditor o/ the county where the property is located•-�q/ /�
Filing Dates: 1) Real Property: Dunng the 12 months belore May 11 oI the year the deduciion is to 7e'eN�"" iC.�" �
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of th JailohTis'to 6e effective.
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See �everse side for addifional instructions and qualifications. '
Applicant own r contract buyer - see ie 'ctions on re e se side)
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Taxing Distri c/� `,^"°' _ Key number / le al d scri ' _ Record number
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Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curcenf year March 1, current year owneR ❑ Yes ❑ No
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If no, what is his / her exac[ share of inlerest? If owned with someone other than spouse, indicate with whom.
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If name on record is different than that ot applicant, indicate below: Is lhe property in question:
❑ Real Property ❑ Mobile Home QC Fr7.1-�
�me of mortgagee or contract seller
Address of mortgagee or contrad selier (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and streef, city, stafe, ZIP code)
Does applicant own property in any olher If yes, what couniy? What Taxing Disirict? Has this dedudion been requested on
county in Indiana? properiy for wrrent yeaRO Yes❑ No
COUNTY AUDITOR
Deduction approved in the amounl of:
20 � 20 �_ 20 _� 20 20 20 20
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SignaWre County Auditor Dale
We certify under the penalty of peryury 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
Signature (ownerS fuli name� Person authorized by duly executed Power oi Attomey
���� or by IC 6-1.1-12-.07
Full reside address of applicant Address of authorized person .