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� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
•. � � ! State Fortn 43709 (RS / 4-03) • . � ,
� PresaiDed by Depanment of Local Govemment Finance
INSTRUCTIONS:
To be �led in person or by mail with the County Auditor of the county where the property is
Filing Dates: 1) Real Property: During the 72 mon[hs belore May 11 of the year the deduction is to be efle�tj� Q 7�806
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year tf��' duct�o is to be effective.
See 2verse side lor additional instrucfions and qualifications. ��� �,�
orcontract buvec- see
Assessed value of real propeAy as of
March 1, current year
number / legal description
Q0� ��49 � � F
MoAgage / Contract indebtedness unpai oas ot
March 1, current year p�
�, � qb
d number
���
number � �, 7
Is the applicant the sole legal or equitable
owneR ❑ Yes ❑ No
If no, whaf is his / her exact share of interesl? �'If ovmed with someone olher than spouse, indicate with whom.
If name on record is different than that of applicanl, indicate below: Is the property in queslion:
�3E �Lv - 3 - /a / // �c ❑ R�i a��ny ❑ Mobife Home QC 61.1-�
�me of mortgagee or conlrad seller �
Address of mortgagee or contrad seller (n ber and street, city, state, ZIP
assignee or other owner or holder of mortgage
Address of assignee (numberand street, city, state, ZIP code)
Does applicant own property in any other I If yes, what counry?
county ir Indiana?
�.. ' ; s.
approv� Drawer N�...::4:.^.:�.........
zo� Card N . ....4.���..........
�41�, CCO. °=
I t I r I
Signature
County Auditor
Taxing Distrid?
\UDITOR
zo
Has this dedudion been requested on
property for wrrent yeaR � YesO No
zo
zo
' We certify under ihe penalty of 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
Signature (owners full name) Person authorized by duly executed Power of Attomey
,� C'- p-- f' l�j,�--_ " orbylC6-1.1-12-.07
of
— Address of authorized person
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