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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 43709 (R6 / 5-06)
Presmbed by Department of Lopl Govemmeni Fina�e
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INSTRUCTIONS: SON COUNTY���1D18�i
To be filed in person or by mail with the CountyAudito� of the county where the p�operty is loca�i� .
Filing Dates: 1) Real P�operty: Dunng the 12 months befo2 June 11 of the year the deduction is to be effective. �
2) Mobile Homes assessed under lC 6-1.1-7: Between January 15 and March 2 0/ the year fhe deductlon is to 6e effective.
See reverse side for additional instnictions and qua/ifications.
Applicant (owner or contract buyer - see reStnctions on re erse side)
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Tauing Distrid Key number / legal description Record nomber �
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Assessed value of real properiy as of Mortgage / Contrad indebtedness unpaid as. of Is the, applicant the sole legal or equitable
March 1, current year March t, current year � ownef? ' �y'es' � No '
9 Oad �
If no, what is his / her exad share of interest? If owned with someone other lhan spouse, indicate with whom.
If name on record is difterent than that of appiicant, indicate below: Is the property in question.
eal Property p Mobile Hane pC 61.1-�
e of moAgagee r coniract seller
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Address of mortgagee or ntract selier (number and street, city, state, ZIP �.
Name of assignee or other owner or holder of mortgage - -- _
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Address of assignee (number and street, city, state. ZIP code)
Does applicant own property in any other If yes, what county? O�+ //� i been requested on
county in Indiana? nt yeaR� Yes❑ No
COUNTY AUDITOR
Dedudion approved in the amount of:
20 �� 20 � 20 20 20 20 20
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Signature County Auditor Date
'' We certify under lhe penalty of perjury that the above and foregoing information is true and correct and that the applicants was / were
esident of Indiana and owner of the aforementioned property on March 1, 20
Signa (owners fuli/name � Person authorized by duly executed Power of Attomey
� or by IC 6-t.t-12-.07
Full resident address of applipnt I 1�.,� Address of authorized person
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